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Enough opioid prescriptions for half of all Americans?

"We're 5% of the world's population, but we consume 80% of the world's prescription opioids," says one Stanford medical researcher of the U.S.

That's a problem, especially because opioid painkillers put people at risk for addiction and overdose. Nevertheless, according to public data analyzed by NPR, enough opioid prescriptions are written each year in the U.S. that half of all Americans could have one. These prescribing rates are widely considered unsafe for patients.

According to the Centers for Disease Control and Prevention, more than 1 in every 5 Americans had an opioid prescription filled in 2018, the most recent year for which full data is available. In that same year, approximately 40 Americans died every day after taking prescription opioids.

It's not just a small group of reckless doctors who are prescribing these vast quantities of dangerous drugs, according to NPR. It's a culture within medicine that treats opioid prescriptions as ordinary and necessary instead of a last resort.

In the 1990s, there was a massive prescribing boom in opioids, partially caused by aggressive, misleading marketing by drug makers. Yet even now, American patients are still receiving nearly twice as many opioid prescriptions than was normal before that boom.

Drug makers blamed for misleading marketing, but what about doctors?

Some pharmaceutical companies have been accused of marketing opioids to doctors by falsely painting them as safe and relatively addiction-free.

Since about 2007, thousands of communities have sued opioid drug manufacturers for their role in the over-prescription of these drugs, which have killed over 450,000 Americans.

In 2014, the American Medical Association set up an opioid task force which was intended, in part, to help doctors reform their prescribing practices.

But those efforts have not been enough to curtail the massive number of prescriptions still being written. In May, a CDC study found that many doctors were ignoring federal guidelines on opioids and continuing to prescribe large quantities of the drugs even when there were better, safer treatment options available.

Even a one-time prescription for opioids comes with a substantial risk for addiction. Somewhere between 1% and 4% of patients develop opioid use disorders after a single prescription.

There appear to be multiple reasons why doctors and dentists prescribe so many opioids when there are safer options that are just as effective. Sometimes the alternatives are less available due to geography, time or insurance problems. Sometimes doctors are under so much time pressure that it is tempting to write a prescription rather than engage in a discussion about pain management.

But the main reason still seems to be a cultural one. For decades, doctors have been trained to treat pain as "the fifth vital sign," needing immediate, aggressive treatment. Is it?

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