Dopesick: It’s not prescription opioid pain pills that Iowans are dying from

A record number of Americans and Iowans are dying from drug overdoses but government officials have not settled on the correct diagnosis of the problem.

Largely driven by opioids, U.S. drug overdoses increased more than 25 percent in a recent 12-month period and topped 100,000 for the first time ever, the federal government reported last week. That’s like the whole population of Davenport being wiped out in a single year. Similarly in Iowa, state officials say midyear data for 2021 show the state is on track to break its overdose record again.

Much attention is paid to the role of prescription painkillers such as OxyContin and Vicodin in the overdose crisis. It’s a tempting explanation to buy into — greedy pharma businessmen got the nation hooked on drugs and now tens of thousands of people are dying from it every year. The truth is much more complicated.

The United States has seemingly won the battle against prescription opioids and traded it out for something much worse.

It is overwhelmingly illicit fentanyl, not prescription pain pills, killing people.

More than 60 percent of overdose deaths in the national data under review were attributed to synthetic opioids such as fentanyl, which is often mixed with heroin or other substances sold illegally. Opioid cases not involving fentanyl accounted for only about 11 percent of U.S. overdose deaths.

Fentanyl deaths have skyrocketed around 2013, the same time the government started looking to crack down prescription painkillers.

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For historical context, the number of fentanyl deaths is now greater than the total number of drug overdose deaths five years ago. Non-fentanyl opioid deaths are around the same level they were in the early 2000s.

In their annual report released this month, Iowa drug enforcement officials reported what they see as good progress on prescriptions: The number of prescription opioids dispensed is down for the fourth straight year, prescribers’ use of the drug monitoring system almost doubled between 2019 and 2020 and the number of drug take-back programs has grown dramatically.

And yet opioid deaths in Iowa are still surging, up more than 50 percent in the past two years and rising again this year. It’s not hard to figure out why — almost 90 percent of documented opioid deaths so far this year in Iowa reportedly involved fentanyl or its analogues.

Iowa drug enforcers suspect there is a gateway from prescriptions to illicit opioids. They note that most heroin users previously misused prescription medications. However, other research shows the overwhelming majority of people who misuse painkillers do not go on to use heroin.

It’s the fentanyl, stupid. And anecdotally, people who use illicit drugs say they are not seeking out fentanyl. It’s put in drugs without users’ knowledge or it is the only substance available to them. Under the American drug prohibition regime, it’s more efficient to traffic fentanyl because it is more potent.

To their credit, Iowa drug policy leaders in recent years have shifted their focus somewhat away from enforcement in favor of prevention and treatment but they still have a long way to go to understanding the causes of the drug crisis.

The United States has seemingly won the battle against prescription opioids and traded it out for something much worse.

(319) 339-3156; adam.sullivan@thegazette.com