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Tighter prescribing regulations drive illicit opioid sales

BMJ 2018; 361 doi: (Published 13 June 2018) Cite this as: BMJ 2018;361:k2480
  1. Scott E Hadland, assistant professor12,
  2. Leo Beletsky, associate professor34
  1. 1Grayken Center for Addiction/Department of Pediatrics, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA
  2. 2Boston University School of Medicine, Division of General Pediatrics, Department of Pediatrics, Boston, MA, USA
  3. 3School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
  4. 4UC San Diego School of Medicine, La Jolla, CA, USA
  1. Correspondence to: SE Hadland scott.hadland{at} and scott.hadland{at}

The predictable consequence of cutting supply without tackling demand

Overdoses claimed 63 632 lives in the United States in 2016, and two third of deaths involved opioids.1 The dynamics of overdose have shifted over time. During the first decade of the US crisis, prescription opioids contributed to most fatalities. As opioid prescribing rates fell after 2010, deaths involving heroin—and more recently, fentanyl—have skyrocketed. Even as opioid prescribing has reached its lowest level in a decade, these less expensive, more available, and highly potent illicit market alternatives continue to drive the surge in fatal poisonings,23 with prescription opioids now contributing to only one in four overdose deaths.14

Policies that suppress access to prescription opioids without reducing demand are known to fail. In a linked paper, Martin and colleagues (doi:10.1136/bmj.k2270)5 consider the unintended consequences of one such supply side intervention, the 2014 rescheduling of hydrocodone combination products from schedule III to schedule II by the US Drug …

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