New Study Finds that Fentanyl Is Grossly Overprescribed

Hands moving stack of prescription sheets.

The term “over-prescribing” is one we hear with frequency today. Over-prescribing is a phenomenon where a doctor administers a prescription for too much of a drug. Such can manifest by a doctor giving a patient a medicine for too long (i.e. the doctor writes the scrip for a very long duration of pills, a sequence of dosages that extend beyond what the patient actually needs). Or it can manifest by a doctor giving a patient a prescription for a drug that is of a higher strength (potency) than what the patient requires.

Fentanyl is one of the most significant problems in the drug scene. And it’s a big problem mostly because of overprescribing. Fentanyl claims more lives than any other drug except for alcohol, mainly because it is overprescribed. New research is starting to suggest that one of the main reasons why fentanyl got so out of control was because it was overprescribed. Fentanyl does have some legitimate uses, but it is overused immensely. Such a trend has carried forward and evolved over the last several years, accumulating to a lethal crisis with opioid overdoses from unnecessary fentanyl consumption.

New Research Shows the Fentanyl Controversy and the FDA’s Involvement In It

An article from USA Today found its way across my desk recently. The report focused on not only fentanyl’s overprescribing but also on the controversy over the fact that the Food and Drug Administration turned a blind eye to it.

According to the research, fentanyl overprescribing has played a big part in the opioid death toll. Forty-seven thousand people died from opioids in 2017. That was the first year where it became more likely that a U.S. resident would die from an opioid overdose than from a car accident.

The USA Today report also highlighted cumulative research from 2012 to 2017 from both Johns Hopkins and Yale universities, plus analysis from the Centers for Disease Control and Prevention. According to their publications, about half of all patients who have been prescribed fentanyl should not have received the drug. Fentanyl is a drug which was only intended for cancer patients.

Here’s where the discoveries become particularly concerning. Not only has 50% of fentanyl prescribing been entirely unnecessary, but it’s been unnecessary for years. And for as long as fentanyl has caused addictions and killed people through overdoses, both the FDA and the drug companies which make fentanyl and its analogs have failed to regulate the drug properly. Furthermore, safeguards were adopted eight years ago to prevent this very phenomenon from developing, and those safeguards have been universally ignored.

According to the research, the FDA does monitor fentanyl disbursement, prescribing, and addiction trends. However, the FDA failed to act on red flags that first started appearing as far back as almost a decade ago. And for the manufacturers of fentanyl, none reported a single instance of a doctor incorrectly prescribing fentanyl. The Johns Hopkins and Yale researchers found that manufacturers did know about over-prescribing and incorrect prescribing trends.

What Is the Purpose of Fentanyl?

Doctor administering fentanyl.

At this point, you may be asking, “If fentanyl is so dangerous, why was it ever made, to begin with?” The reason is simple enough. Fentanyl was initially designed for cancer patients who were already somewhat “opioid-tolerant.” This means that the drug was made for patients who sometimes experienced pain that would overwhelm their current regimen of pain relievers.

This type of pain is called “breakthrough pain.” It is a pain so severe that, even if a patient is currently taking OxyContin or Vicodin or Percocet or something of that nature, the sensation of pain will overwhelm the effect of the painkillers that the patient is now on. Breakthrough pain is common among cancer patients.

Another factor to note is that fentanyl was only ever intended for people who were already taking not-insignificant doses of opioid painkillers. Hence, fentanyl was only ever meant to be used on patients who were already somewhat opioid tolerant. It follows logically then, that if someone who took fentanyl was not opioid-tolerant, the result could easily be a lethal one for them.

“The million-dollar question is, how on earth did such high rates of unsafe use occur when these products were subject to one of the most restrictive distribution systems that the FDA
and manufacturers have?”

Caleb Alexander, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health and someone who helped author the above research also commented on this issue, saying that “The million-dollar question is, how on earth did such high rates of unsafe use occur when these products were subject to one of the most restrictive distribution systems that the FDA and manufacturers have?”

Dr. Alexander went on to say that, “These are not your typical products. The risks of these products are not typical risks. If these products are used among patients who are not already what we call ’opioid-tolerant’ and are on around-the-clock opioids, they can be fatal. They can kill you.”

Reducing Prescribing of Fentanyl

Doctor prescription.

The clear answer here is to reduce the prescribing of fentanyl and to sharply cut down on how intensively this drug is given to patients. Since the FDA and drug manufacturers dropped the ball on making changes when they knew fentanyl was being grossly over-prescribed and grossly misused, we cannot assume that they will do much about it going forward.

So we have to take this problem into our own hands.

It starts with getting informed about fentanyl and ensuring that you and no one else you know is taking this drug unless they need to and for legitimate reasons. The next step involves talking to doctors, writing to medical boards, joining patient interest groups, and so on. We have to advocate for reform in not only opioid production and distribution, but we have to get our local doctors to significantly cut back on their prescribing.

More Information on Addiction Risk and Getting Informed has an extensive database of information and resources on opioid pharmaceuticals, their risk, how to tell if someone is becoming addicted to them, how to get help, how to convince a loved one to get help, etc. If you know someone who is hooked on fentanyl and needs help, read this article.

And this article has more information on opioid addiction in general.

Last but not least, this piece expands beyond fentanyl and discusses risks attendant with other prescription drugs.

Knowing what to take when it comes to medicine has become a challenge that none of us likely ever saw happening two decades ago. Who would have thought that the very pharmaceutical drugs which are supposed to help us would grow more dangerous than street drugs? Looking to the future, let’s proceed with caution, do our research on various medicines, and always be ready to help family members and loved ones should they struggle with a particular medication.


Reviewed and edited by Claire Pinelli, ICAADC, CCS, LADC, RAS, MCAP



After working in addiction treatment for several years, Ren now travels the country, studying drug trends and writing about addiction in our society. Ren is focused on using his skill as an author and counselor to promote recovery and effective solutions to the drug crisis. Connect with Ren on LinkedIn.