Opinion: Hospitals aren’t the source of America’s opioid epidemic

To the editor: Johann Hari understates the risks of prescription opioids, including addiction, which the best data available suggest develops in up to 10% of patients with chronic pain. Chronic pain is the dominant reason for the surfeit of prescription opioids in North America, not treatment of acute pain in hospitals, as Hari describes. (“What’s really causing the prescription drug crisis?” Opinion, Jan. 12)

Other serious harms of opioids include falls, motor vehicle collisions, sleep apnea, testosterone suppression, paradoxical worsening of pain, depression and accidental overdose. Physical dependence — a construct distinct from addiction — explains why patients can be, in Hari’s words, “plunged into needless pain” following abrupt dose reductions.

Hari is correct that reduced prescribing alone will not solve the opioid crisis. Addiction is a public health problem requiring access to skilled care, medications like buprenorphine and the antidote naloxone, and supervised consumption sites.

But doctors must also prescribe opioids more judiciously. Doing so will necessarily improve the well-being of patients with pain.

David Juurlink, MD, Toronto

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To the editor: Hari overlooks the significant role of direct-to-consumer advertising in creating such a massive demand for a wide range of powerful, dangerous and addictive drugs (especially opiates) in our society.

It is no coincidence that this crisis began right when TV advertising of prescription drugs was first permitted in the U.S. in the 1990s. Many other countries ban such advertising.

This is some of the most ubiquitous, expensive, emotionally manipulative and, unfortunately, effective advertising on television today. As long as these ads continue to air, there will continue to be a “prescription drug crisis.”

Craig M. Loftin, Long Beach

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