Relationship Between Patients Dispensed Prescription Opioids, Opioid Treatment Admissions and Overdose Deaths: 2006-2018 and Beyond

Background: In August 2022, a paper was published by Larry Aubry and L. Thomas Carr, assessing relationships between prescription opioid sales, opioid treatment admissions and drug-related accidental deaths. This paper refines and expands the previous work by analyzing the relationship between the patients dispensed an opioid prescription to drug overdose deaths and opioid treatment admissions. It evaluates whether there is a statistically significant relationship between opioid prescribing in the current year and the subsequent year (Year + 1) and the year after that (Year + 2) opioid treatment admissions or drug overdose mortality rates. 2020-2022 data are also examined to refine understanding of the primary driving factors in U.S. accidental drug mortality. Aims: This paper seeks to more fully answer the question, "Have prevailing public health policies restricting the availability of prescription opioid analgesics been successful in reducing accidental drug overdoses, either from all drugs or specifically from prescription opioids?" Methods: Linear regression analysis has been applied to data published by the US CDC and the U.S. Food and Drug Administration from 2006 to 2018 – six years before and six years after a peak in U.S. opioid analgesic prescribing. 2020-2022 data from the CDC State Unintentional Drug Overdose Reporting System have been examined for trends and consistency with earlier data. Four measures have been applied: statistical significance of the model (overall P-value), quality of the data fit (R-squared), and the sign of the linear slope coefficient (positive or negative correlation) proportion of patients dispensed an opioid prescription to opioid treatment admissions and to deaths attributed to prescription opioid drugs. Results: No positive correlations were found between the number of patients dispensed an opioid prescription versus present-year, present-plus--year, or present-year-year+2 prescription opioid mortalities, opioid treatment admissions, and any opioid and total overdose deaths. Recent accidental drug-related deaths are dominated by non-prescription opioids, specifically illegal fentanyl and stimulants– not patients dispensed an opioid prescription. Conclusions: Current public health policy restricting the availability of clinically prescribed opioid analgesics has had no discernable effect on opioid treatment admissions or drug overdose/poisoning mortality.