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The real cause of America’s opioid crisis: Doctors are not to

blame
Richard A. Lawhern, PhD ⋮ ⋮ 3/22/2023

We’ve all heard about America’s so-called “opioid epidemic.” Nearly 100,000 people died in 2021 of causes
that included overdose by one or more narcotic drugs and often alcohol. We also hear assertions from anti-
opioid advocates that this epidemic was caused by doctors “over-prescribing” opioid pain relievers to their
patients. These assertions are fundamentally wrong on fact. U.S. national health care policy and law
redirections are needed to correct such distortions.

Doctors prescribing to their patients did not create the U.S. opioid crisis.

Undeniably, America is undergoing a public health crisis in rising rates of drug addiction and tens of
thousands of yearly drug-overdose-involved deaths. However, it is equally undeniable that doctors did not
cause this crisis by over-prescribing opioid pain relievers to their patients. Illegal street drugs instead drive
our “crisis,” primarily fentanyl imported from Mexico and China.

As Dr. Nora Volkow (director of the National Institute on Drug Abuse) and Thomas A McMillan noted as early
as 2016,” addiction is not a predictable result of opioid prescribing. Addiction occurs in only a small
percentage of persons exposed to opioids — even among those with pre-existing vulnerabilities.”

Our real crisis is instead driven by the socio-economic determinants of health; it is one of hopelessness
rooted in 50 years of wage stagnation, ever-increasing wealth inequality, under-investment in national
economic infrastructure, and the hollowing-out of the rust belt, rural and inner-city communities by structural
poverty, leading to the collapse of family support systems. Vulnerability to addiction is created by the
circumstances in which people live, not by medical exposure.

These realities are vastly misunderstood by the Centers for Disease Control and Prevention, the Veterans
Administration, and law enforcement agencies, particularly the Drug Enforcement Agency. Despite repeated
false claims of an “association” between prescribing and opioid deaths, data published by the CDC itself
directly contradict such conclusions.

For millions of Americans, long-term opioid therapies are the only treatments that make severe pain
manageable and preserve limited quality of life. However, U.S. public health policy is killing patients in
wholesale lots by forcing doctors out of pain medicine and patients into street markets or suicide.

When it is understood that doctors are not now — and likely never were — the primary source of America’s
opioid crisis, much of current public policy on addiction, overdose deaths, and harm reduction is revealed to
be either profoundly misdirected or outright fraudulent nonsense. 

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What must be done today? 

America’s opioid crisis is multi-dimensional. So also must be needed redirections of health care policy. Some
of these redirections will likely require new laws.

Corrections at the federal level

1. Immediate public withdrawal and repudiation of the fatally flawed and actively dangerous 2016 and 2022
revised CDC guidelines on the prescription of opioids, with notification of State Medical Boards and
Departments of Health that these guidelines should no longer be used as references in State health care
regulatory documents.

2. Immediate public repudiation of the Department of Veterans Affairs and Department of Defense May 2022
“Clinical Practice Guideline for the Use of Opioids in the Management of Chronic Pain” and the related
“Opioid Safety Initiative.” Both documents suffer from the same cherry-picking and misrepresentation of
research that is deeply evident in the CDC guidelines.

3. Amendment of the Controlled Substances Act of 1970 to halt pre-trial asset confiscations directed against
clinicians; coercing clinician staff with threats of prosecution if they do not testify against clinicians must also
cease.
4. An immediate stand-down order to the Drug Enforcement Agency is needed, halting prosecutions of
clinicians until the publication of definitive standards for judge and jury instruction under the 2022 Supreme
Court decision in Ruan v. the United States. Such standards must be accompanied by a related standard for
qualification of “expert witness” testimony submitted against clinician defendants.

5. Given the current artificial shortage of critical anesthetic and analgesic medications caused by the DEA,
the authority of that Agency to set production quotas on scheduled medications must be rescinded.

At the state level

6. All states should replace laws that limit patient access to opioid medications under medical supervision or
create sanctions against clinicians who prescribe opioid analgesics within their own best understanding of
patient needs. Models for policy redirection are offered in recent legislation passed in New
Hampshire, Rhode Island, Oklahoma, Arizona, and  Minnesota.

Replacement of CDC and VA practice guidelines

7. The FDA or National Academies of Medicine should convene a one-year consensus conference on
clinical practice standards for treating acute and chronic pain, supported by clinical specialty academies and
Boards. Conference participants should have hands-on professional experience in hospital and community
medical practice for pain management.   Voting participants should also include chronic pain patients or their
advocates. An interim draft should be published via the Federal Register for public comment. Actions in
response to every comment must be tracked and reported.

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The 2018-2019 Department of Health and Human Services Inter-Agency Task Force on Best Practices in
Pain Management offers a model for processes to ensure public transparency and scientific accuracy.

A plea for help and a demand for change 

Millions of U.S. citizens now live every day in a nation in pain. Much of their pain is now caused by
misdirected public health policy and outright fraudulent misrepresentation of the risks and benefits of
prescription opioid medications. Even officials who have “inherited” this debacle must surely acknowledge
that if they aren’t part of the solutions, they are part of the problem.

The message to government decision-makers is clear: We will no longer be silent. We demand your
immediate actions on our behalf.

Richard A. Lawhern is a patient advocate.

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