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Ralph Reiland

Wars & the opioid epidemic

| Sunday, Dec. 14, 2014, 9:00 p.m.

U.S. fatalities totaled 4,489 in Iraq, 2003 through 2014, an average of 408 fatalities per year.

U.S. fatalities totaled 2,354 in Afghanistan, 2001 through 2014, an average of 181 fatalities per year.

That's a total of 6,843 U.S. deaths — 69 percent age 20 to 29.

To portray this toll beyond stark statistics, The Washington Post's “Faces of the Fallen” lists the men and women killed in Iraq and Afghanistan with a photo and a short biography of each.

Pictorially, the “Faces of the Fallen” pages look like a college or high school yearbook — except, unfortunately, with more pages. With 100 photos per page, the lengthy and dismaying compilation of youthful faces, all prematurely dead, would go on, to date, for 69 pages.

Still, as costly as the aforementioned is in terms of lost lives, the yearly averages of U.S. fatalities of 408 and 181 in Iraq and Afghanistan pale in comparison with the number of lives lost annually in the U.S. from overdoses of pain pills.

“Deadly Pain Pills: Every day, 46 people in the U.S. die from legal pain pills” begins the cover article in the September 2014 issue of Consumer Reports magazine.

That's 16,790 deaths per year in the U.S. from legal pain pills — more than double, in one year, the total U.S. fatalities in the Iraq and Afghanistan wars.

“And for every death, more than 30 people are admitted to the emergency room because of opioid complications,” according to Consumer Reports. That's 503,700 people per year, on top of the 16,790 deaths.

“It starts with drugs such as OxyContin, Percocet and Vicodin — prescription narcotics that can make days bearable if you are recovering from surgery or suffering from cancer,” states Consumer Reports. “But they can be as addictive as heroin and are rife with deadly side effects.”

The use of and problems with the aforesaid three drugs and other opioids have tripled and quadrupled in recent years, with the increases in deaths from overdoses paralleling or exceeding the increases in sales and usage.

“Prescriptions have climbed 300 percent in the past decade,” while overdose deaths from these legal drugs are “up more than 400 percent from 1999,” reports Consumer Reports. “Vicodin and other drugs containing the narcotic hydrocodone are now the most commonly prescribed medications in the U.S.”

Additionally, it's a misconception to suppose that the people in trouble with these drugs have doctor-shopped, exceeded recommended doses or bought pills on the street. “About 60 percent of overdoses occur in people prescribed by a single physician,” reports Consumer Reports, and “a third of those were taking a low dose.”

The group Physicians for Responsible Opioid Prescribing ( provides an overview of the costs and benefits: “No randomized trials show long-term effectiveness of high opioid doses for chronic non-cancer pain. … Patients using prescription opioids are at risk of unintentional overdose and death and this risk increases ... when opioids are combined with CNS depressants like benzodiazepines and alcohol. … With daily opioid use, physical dependence and tolerance can develop in days or weeks. … Estimates vary concerning addiction, but between 4 percent and 26 percent of patients receiving medically prescribed chronic opioid therapy have an opioid use disorder.”

Ralph R. Reiland is an associate professor of economics at Robert Morris University and a local restaurateur (

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