Articles, References, & Studies
Overview of New Studies Re: Opioids - Article by Jeffrey Singer
Evidence Pours More Cold Water on The False Narrative That Prescriptions Caused the Opioid Crisis
By Jeffrey A. Singer Twitter LinkedIn Reddit Facebook
A new study reported in the November 1, 2019 Annals of Emergency Medicine pours more cold water on the false but persistent narrative that the opioid overdose crisis was caused by doctors prescribing opioids to patients in pain.
This prospective cohort study by researchers in the Department of Emergency Medicine at Albert Einstein College of Medicine followed 484 “opioid naïve” patients prescribed opioids for acute pain upon release from the emergency department during a six month period. The statewide prescription drug monitoring program was employed in addition to regular follow up telephone interviews. One percent (five patients) met the criteria for persistent opioid use by the end of the follow up period. Four of the five patients still had moderate or severe pain in the affected body part six months after release from the emergency department.
The study comes after a much larger retrospective cohort study reported in the BMJ of more than 568,000 opioid naïve patients prescribed opioids for acute postoperative pain between 2008 and 2016. Investigators found a total misuse rate of 0.6 percent. The researchers defined “misuse” as follows:
The primary outcome was an ICD-9 (international classification of diseases, ninth revision) diagnosis code of opioid dependence, abuse, or overdose…Opioid misuse was defined as the presence of at least one of these ICD codes after discharge and encompasses a composite of a wide range of forms of misuse. We included only diagnosis codes related specifically to prescription opioids.
As previously reported here and here, there is no correlation between opioid prescription volume and non-medical use or opioid use disorder among persons age 12 and over. But policymakers and law enforcement continue to pressure health care practitioners into undertreating patients in pain. At a recent international breast cancer conference experts stated the under-prescribing of opioids to breast cancer patients in the U.S. is now comparable to treatment in third world countries.
Recently the Centers for Disease Control and Prevention, in a written clarification, stated that policymakers and legislators are misapplying and misinterpreting its 2016 opioid prescribing guidelines. The CDC statement pointed out that its guidelines were never intended to be “prescriptive,” but were meant to serve as a rule of thumb, recognizing that providers know their patients’ situations best, and should weigh risks and benefits when treating individuals in pain.
Despite the recent exhortation from the CDC, most states and many pharmacies maintain the limits on the dose and number of opioids that can be prescribed to patients that were put into effect in response to the 2016 CDC guidelines.
Meanwhile, as prescription volume precipitously drops, the overdose rate continues apace, with fentanyl and heroin now making up the overwhelming majority of overdose deaths. And now methamphetamine is making a comeback as a major cause of drug deaths—15 years after Congress addressed the “meth crisis’ with the Combat Methamphetamine Epidemic Act.
Until the war on drugs comes to an end and the focus shifts to harm reduction, the only thing that will change going forward will be the particular drug responsible for the latest “overdose crisis.” That should be the narrative.
Source: Cato Institute
More from Cato: Myth of an Opioid Prescription Crisis
Download the Policy Report
Evidence Against the CDC Guidelines for Prescribing Opioids for Chronic Pain
Articles Against the Legitimacy of CDC Guidelines
- Opioids, Addiction, and Pain: Briefing for Policy Leaders
- CDC Manipulated Data to Deceive
- CDC Guidelines Refuted with Scientific Evidence
- The Changing Opioid Epidemic: Not from Rx
This excellent summary of the points of our argument against the CDC Guidelines was created by Stefan G Kertesz, MD, who also wrote the thoroughly researched paper, The Changing Opioid Epidemic: Not from Rx, proving that our opioid prescriptions are NOT the problem.
This briefing was presented personally to U.S. Surgeon General Vivek Murthy on January 17, 2017. He was receptive to the points offered here.
2. CDC Manipulated Data to Deceive – November 29, 2016
This commentary presents the case that the CDC manipulated the data it used as a basis for its opioid prescribing guidelines.
By imposing an arbitrary non-standard constraint and excluding some studies that were included in earlier reports, the CDC created a different interpretation by using a different set of data.
Objectives. A recent US federal review and clinical guideline on opioids for chronic pain asserted that the literature contributes no evidence on efficacy because all trials had “inadequate duration.”
3. CDC Guidelines Refuted with Scientific Evidence – September 8, 2016
Neat, Plausible, and Generally Wrong: A Response to the CDC Recommendations for Chronic Opioid Use – Stephen A. Martin, MD, EdM; Ruth A. Potee, MD, DABAM ; and Andrew Lazris, MD
Finally, someone is standing up for the truth about opioids and pain patients. These three courageous M.D.s expose the CDC guidelines for the fraud […]
4. The Changing Opioid Epidemic: Not from xR – November 22, 2016
Turning the Tide or Riptide? the Changing Opioid Epidemic – Stefan G. Kertesz – 18 Nov 2016
This rigorously sourced paper illustrates the absurdity and futility of the crackdown on prescribed pain medication.
Dr. Kertesz meticulously lays out the facts (backed by 50 references to scientific research) proving that opioid prescriptions to patients are not the primary driver of the increasing numbers of overdose deaths.
Restricting such prescriptions has only caused a crisis of untreated pain while doing absolutely nothing to treat the addiction and abuse at the root of most overdoses.
More Professional Critiques of the Guidelines
“Research” Behind the CDC’s Opioid Guidelines – August 2016
Tracking Down the “Research” Behind the CDC’s Opioid Prescribing Guidelines – National Pain Report – Aug 2016 – By Richard “Red” Lawhern, PhD
I have tracked down some of the “research” behind the so-called CDC practice guidelines published in March 2016. And the research is an absolute CROCK! Particularly astounding is the biased and unscientific […]
Opioids, Pain and the CDC’s Guideline: Needs Improvement – January 24, 2016
Opioids, Pain and the CDC’s Guideline: Needs Improvement | by Stefan Kertesz Physician researcher
These arguments against the CDC’s guidelines are specific, logically argued, and carefully thought out, explaining some aspects that seemed muddled, but are clear to a practicing doctor. The Centers for Disease Control report that 2014 saw a record of 18,893 deaths related to opioid […]
Professional Criticism of CDC Guidelines – April 25, 2016
CDC Issues Final Guidelines for Opioid Prescribing: PPM Editorial Board Responds
This is a 6-page article, with some thoughtful criticism of the guidelines, addressing some of their striking shortcomings. The initial draft guidelines were met with sharp criticism from a number of medical organizations, including the American Academy of Pain Medicine (AAPM), American Medical Association […]
Issues With the CDC Guidelines – October 3, 2016
The Issues With the CDC Guidelines on Opioids for Chronic Pain, According to AAPM’s Director by Florence Chaverneff, Ph.D. September 26, 2016
This article is noteworthy because of where it appears (in a publication mostly dedicated to parroting the CDC’s ideas) and who is speaking (BobTwillman, president of the American Association of Pain Management) In […]
CDC Opioid Guidelines–A Threat To Pain Patients’ Lives – September 27, 2015
These guidelines were designed to further curb opioid abuse. But in fact, they seem to be about arbitrarily curbing treatment.
CDC Opioid Prescribing Guidelines–A Threat To Pain Patients’ Lives | Intractable Pain Journal
CDC Guidelines Use Pseudoscience – April 17, 2016
How Opioid Prescribing Guidelines Use Pseudoscience — Pain News Network – By Michael Schatman and Jeffrey Fudin, Guest Columnists – March 30, 2016
Recently, we (along with our colleague, Dr. Jacqueline Pratt Cleary) published an open access article in the Journal of Pain Research, entitled “The MEDD Myth: The Impact of Pseudoscience on Pain Research […]
Long List of Flaws with CDC Guidelines – April 5, 2016
National Pain Strategy 0; Drug Wars 1 | Terri A. Lewis, Assistant Professor, Rehabilitation Counseling & Intern’l Prgms Cnsltnt at National Changhua University of Education | Mar 20, 2016
Ms. Lewis has organized the salient points of the current denigration (assault) of pain patients. Her bullet points help my frazzled mind understand what has happened […]
Draft CDC Opioid Guideline: Pain Medicine Experts Discuss – March 3, 2016
Below I’ve tried to limit this long discussion to its most meaningful statements. I spent much time highlighting and commenting on the most pertinent phrases, so I hope you find this post informative.
This discussion gives an interesting view of how pain and pain […]
FDA Endorses Biased and Unscientific CDC Opioid Guidelines – February 14, 2016
FDA Endorses CDC Opioid Guidelines | February 04, 2016 | By Pat Anson, Editor
In a move that may have more to do with politics than healthcare, the U.S. Food and Drug Administration has set aside the advice of its own experts by endorsing the CDC’s controversial guidelines for opioid prescribing The move is part […]
A Reviewer’s Analysis of the Draft CDC Guidelines – January 9, 2016
A Former Federal Peer Reviewer’s Analysis of the Draft CDC Guidelines | National Pain Report | December 30, 2015 | Brooke Lee Keefer
In my former life prior to chronic pain and illness I had many important and fascinating jobs. One was as a peer reviewer for the United States National Institutes for Health (NIH), Center for Mental […]
CDC Opioid Guidelines: Good, Bad, and Ugly – May 22, 2016
New CDC Opioid Guidelines: The Good, the Bad, and the Ugly – Charles E. Argoff, MD – May 13, 2016
In this article, Dr. Argoff picks apart the guideline and explains which parts are relatively sound, and which are spurious. The guideline’s purpose is to: “improve communication between clinicians and patients about the risks and […]
Response to CDC Guidelines by FMS Assoc. – March 27, 2016
NFMCPA Response to CDC Opioid Prescribing Guidelines | March 13, 2016 | Jan Favero Chambers, President/Founder | National Fibromyalgia & Chronic Pain Association
Today at noon I could hardly breathe. Hot tears fell on my cheeks, and a deep heartache filled my soul. The U.S. Centers for Disease Control Guidelines for Prescribing Opioids 2016 was […]
Professional Criticisms of CDC Guidelines – March 24, 2016
Responses and Criticisms Over New CDC Opioid Prescribing Guidelines | March 18, 2016
In their statements, both the American Academy of Pain Medicine (AAPM) and the American Medical Association (AMA) first cautiously express approval of the CDC’s intentions (obviously intimidated) before diving into the glaring problems with the guidelines. I feel the worst part is the fixed […]
Docs Say CDC Opioid Guidelines Misguided – April 13, 2016
CDC Opioid Prescribing Guidelines Misguided, Docs Say | Brandon Cohen | April 08, 2016
Recent guidelines handed down from the Centers for Disease Control and Prevention (CDC) concerning the prescription of opioids have made waves among healthcare professionals. The CDC condemned the practice of prescribing these drugs in the vast majority of cases. Furthermore, these guidelines […]
Contradictions in CDC Guidelines – Jan 2016
Upon review of the Proposed 2016 CDC Guideline for Prescribing Opioids for Chronic Pain we find various contradicting statements based on the presented evidence and the recommendation strength
According to the National Guideline Clearinghouse, “level A rating requires at least two consistent Class I studies”.
However, all of the 12 recommendations provided are based on case series (level 3 evidence) or expert opinion (level 4 evidence) yet assigned a grade A recommendation.
Harms Associated With Conflation of Data – Feb 2017
By Stephen Ziegler, PhD
The research letter, like many articles authored by those who are rightly concerned about addiction and overdose, begins by asserting that an association exists between increases in opioid prescribing and “large increases in addiction and overdose deaths in the United States.”
However, there are several problems with such a statement. First, association is not causation.
Further, it is misleading and harmful to lump all opioids, prescription and illicit, together.
An Excellent Source of the Latest, Most Comprehensive Collection of Articles and Reference Materials Regarding Chronic Pain and Illnesses
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National Institute on Drug Abuse (NIDA)
National Institute on Drug Abuse (NIDA)
Mission
The mission of the National Institute on Drug Abuse (NIDA) is to advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health. In this regard, NIDA addresses the most fundamental and essential questions about drug abuse — from detecting and responding to emerging drug abuse trends and understanding how drugs work in the brain and body, to developing and testing new approaches to treatment and prevention. NIDA also supports research training, career development, public education, public-private partnerships, and research dissemination efforts. Through its Intramural Research Program, as well as grants and contracts to investigators at research institutions around the country and overseas, NIDA supports research to:
- Identify the biological, environmental, behavioral and social causes and consequences of drug use and addiction across the lifespan;
- Develop improved strategies to prevent drug use and its consequences;
- Develop new and improved treatments to help people with substance use disorders achieve and maintain a meaningful and sustained recovery;
- Increase the public health impact of NIDA research and programs
In line with these goals, NIDA works to ensure that the following cross-cutting themes are addressed across institute programs and initiatives:
- advancing basic research on neuroscience and biology
- leveraging technology
- driving innovation
- increasing scientific rigor and reproducibility
- building a strong, diverse, multidisciplinary scientific workforce
- promoting collaboration
- encouraging data and resource sharing (data harmonization)
- supporting health equality
- increasing the real-world relevance of research (translation)
Share with your State and Federal Representatives
Damaging State Legislation Regarding Opioids: The Need To Scrutinize Sources Of Inaccurate Information Provided To Lawmakers
Authors Schatman ME, Shapiro H
DOI https://doi.org/10.2147/JPR.S235366
Politics of Pain
Setting the Stage - Monetizing the Opioid "Crisis"
The "ANTI OPIOID" Lobby's Strategy to Discredit & Demonize the Responsible use of Prescription Pain Medications for Legitimate Medical Purposes.
Political Attempts to Solve Opioid Crisis
House Tackling Opioid Crisis + Much More
http://www.speaker.gov/general/house-tackling-opioid-crisis-much-more
The Hill: House’s opioid response will not include new funding, aide says http://thehill.com/policy/healthcare/277036-houses-opioid-response-will-not-include-new-funding-aide-says
Speaker Ryan: ‘We Can Win This Battle’ against Opioid Addiction http://www.speaker.gov/general/speaker-ryan-we-can-win-battle-against-opioid-addiction
WP: Some fear House playing politics with painkiller bills https://www.washingtonpost.com/news/powerpost/wp/2016/04/13/some-fear-house-playing-politics-with-painkiller-bills/?tid=sm_tw
Leader McCarthy: This Epidemic Sent More Than 100 Of My Constituents To The E.R., But Congress Is Fighting Back http://opinion.injo.com/2016/04/254920-160-of-my-constituents-have-overdosed-on-opioids-since-2010-were-taking-action-to-stop-the-epidemic/?utm_content=bufferd9fe5&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer
Markey Commends Obama Administration Efforts to Expand Treatment and Education for Opioid Addiction http://www.markey.senate.gov/news/press-releases/markey-commends-obama-administration-efforts-to-expand-treatment-and-education-for-opioid-addiction
FDA Press Release: FDA announces enhanced warnings for immediate-release opioid pain medications related to risks of misuse, abuse, addiction, overdose and death http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm491739.htm
The Hill: Senate GOP blocks emergency funding for opioid epidemic http://thehill.com/blogs/floor-action/senate/271533-senate-gop-blocks-emergency-funding-for-opioid-epidemic
Medical News
Articles
ACSH
IV Tylenol As Good As Moose Urine For Post-Op Pain Control
'New' Opioid Crisis: Dr. Vanila Singh Warns of Adulterated Street Drugs
Gee, Pain Pills Are the Real Not Killers. And the Sun Rises in the East. Who Knew?
From China White to Breaking Bad: The Rand Report on Fentanyl In America
ACSH Explains: What's the Difference Between Opioids and Opiates?
Rand Report on Fentanyl: Mostly Correct (but ACSH Got There Long Ago)
It's Not Wrong To Ask Your Doctor For Opioids
Reader's Digest 'Advice' On Drugs Is Biased And Ignorant
Doctors and Legislators: Listen to Patients, Not the CDC
Overprescription or Recreation: What Is Driving the Opioid Epidemic?
Medpage Today
Escalating Opioid Doses in Chronic Pain
Prospective study looks at outcomes of long-term opioid use
13 COMMENTS
Opioid Stigma and Cancer
Efforts to limit opioid prescribing may have unintended consequences
Can Blocking Kappa Receptors Reduce Opioid Dependency?
Researchers look at targeting pain-related anhedonia
7 COMMENTS
Kids' Chronic Pain and Life Challenges Go Hand-in-Hand
Risk factor for poorer school function, as well
Heroin Use in Pain Patients Signals Something Badly Amiss
Tied to other illicit drug use, non-adherence to prescribed opioids
13 COMMENTS
Sensitivity Heightened with Chronic Low Back Pain
Catastrophizing is also a common feature
8 COMMENTS
Cannabis Not a Pain Aid for Opioid Users
Sleep quality also not influenced by use
21 COMMENTS
Parents Play Big Role in Child's Chronic Pain
Self-blame from parent seen as particularly important factor
Pain News Network
By Pat Anson, PNN Editor
Biden: ‘A Little Pain Is Not Bad’
Read More →
More Overdoses Blamed on Kratom
Read More →
CDC Director Says Agency Will ‘Clarify’ Opioid Guideline
Read More →
CDC: Guideline ‘Not Intended to Deny Any Patients Opioid Therapy’
Read More →
FDA Warns About Fast Opioid Tapers
Read More →
REASON:
Opioid Commission Mistakenly Blames Pain Treatment for Drug Deaths
Researchers Highlight the Government’s Complicity in Heroin Deaths
Studies & Reports
Opioids
- 2016 National Drug Threat Assessment Summary Show summary Open resource [pdf] (open full abstract) United States. Drug Enforcement Administration 2016-11
- Centers for Medicare & Medicaid Services (CMS) Opioid Misuse Strategy 2016 Show summary Open resource [pdf] (open full abstract) Centers for Medicare & Medicaid Services (U.S.) 2017-01-05
- Combatting the Opioid Epidemic: A Review of Anti-Abuse Efforts in Medicare and Private Health Insurance Systems Show summary Open resource [pdf] (open full abstract) United States. Congress. Senate. Committee on Homeland Security and Governmental Affairs 2016-10-04
- Continuing Progress on the Opioid Epidemic: The Role of the Affordable Care Act Show summary Open resource [pdf] (open full abstract) United States. Department of Health and Human Services 2017-01-11
- Executive Order 13784: Establishing the President's Commission on Combating Drug Addiction and the Opioid Crisis Show summary Open resource [pdf] (open full abstract) United States. Office of the Federal Register Trump, Donald, 1946- 2017-03-29
- Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health Show summary Open resource [pdf] (open full abstract) United States. Public Health Service. Office of the Surgeon General; United States. Substance Abuse and Mental Health Services Administration 2016
- Families in Crisis: The Human Service Implications of Rural Opioid Misuse Show summary Open resource [pdf] (open full abstract) National Advisory Committee on Rural Health and Human Services (U.S.) 2016-07
- Federal Response to the Opioid Abuse Crisis, Hearing Before the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies of the Committee on Appropriations, U.S. House of Representatives, One Hundred Fifteenth Congress, First Session, April 5, 2017 Show summary Open resource [pdf] (open full abstract) United States. Congress. House. Committee on Appropriations 2017-04-05
- Final Report: Opioid Use, Misuse, and Overdose in Women Show summary Open resource [pdf] (open full abstract) United States. Department of Health and Human Services. Office on Women's Health 2017-07-19
- Healthcare Payer Strategies to Reduce the Harms of Opioids Show summary Open resource [pdf] (open full abstract) Centers for Medicare & Medicaid Services (U.S.) 2017-01
- Heroin Trafficking in the United States [August 23, 2016] Show summary Open resource [pdf] (open full abstract) Library of Congress. Congressional Research Service Finklea, Kristin M. 2016-08-23
- National Drug Control Strategy 2015 Show summary Open resource [pdf] (open full abstract) United States. Executive Office of the President 2015
- National Heroin Threat Assessment Summary - Updated Show summary Open resource [pdf] (open full abstract) United States. Drug Enforcement Administration 2016-06
- Opioid Epidemic and Federal Efforts to Address It: Frequently Asked Questions [October 18, 2017] Show summary Open resource [pdf] (open full abstract) Library of Congress. Congressional Research Service Sacco, Lisa N.; Bagalman, Erin 2017-10-18
- Pandemic Vaccine Distribution Policy for the Twenty-First Century Show summary Open resource [html] (open full abstract) Naval Postgraduate School (U.S.). Center for Homeland Defense and Security Russo, Tom 2012-02
- Patient Characteristics of Opioid-Related Inpatient Stays and Emergency Department Visits Nationally and by State, 2014 Show summary Open resource [pdf] (open full abstract) United States. Agency for Healthcare Research and Quality Weiss, Audrey J.; Bailey, Molly K.; O'Malley, Lauren . . . 2017-06
- President's Commission on Combating Drug Addiction and the Opioid Crisis, Final Report Show summary Open resource [pdf] (open full abstract) United States. President's Commission on Combating Drug Addiction and the Opioid Crisis 2017-11-01
- Recommendations on Selection and Use of Personal Protective Equipment and Decontamination Products for First Responders Against Exposure Hazards to Synthetic Opioids, Including Fentanyl and Fentanyl Analogues Show summary Open resource [pdf] (open full abstract) InterAgency Board 2017-08
- Serial No. 114-34: Combating the Opioid Abuse Epidemic: Professional and Academic Perspectives, Hearing Before the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, House of Representatives, One Hundred Fourteenth Congress, First Session, April 23, 2015 Show summary Open resource [pdf] (open full abstract) United States. Government Publishing Office 2015
- Serial No. 114-38: What is the Federal Government Doing to Combat the Opioid Abuse Epidemic? Hearing Before the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, U.S. House of Representatives, One Hundred Fourteenth Congress, First Session, May 1, 2015 Show summary Open resource [pdf] (open full abstract) United States. Government Publishing Office 2015
- Serial No. 114-46: What are the State Governments Doing to Combat the Opioid Abuse Epidemic? Hearing Before the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, U.S. House of Representatives, One Hundred Fourteenth Congress, First Session, May 21, 2015 Show summary Open resource [pdf] (open full abstract
Article by Dr. Shactman:
https://www.dovepress.com/getfile.php?fileID=53892
October 2019
Timeline of Events
Source: Joy Johnson Wilson and Rachel B. Morgan RN, BSN
10/22/2015
White House Announcement 2015
The Obama administration issued a memorandum on Oct., 21, 2015, to federal departments and agencies directing two important steps to combat the prescription drug abuse and heroin epidemic:
- Prescriber Training: First, to help ensure that health care professionals who prescribe opioids are properly trained in opioid prescribing and to establish the federal government as a model, the presidential memorandum requires federal departments and agencies to provide training on the prescribing of these medications to federal health care professionals who prescribe controlled substances as part of their federal responsibilities.
- Improving Access to Treatment: Second, to improve access to treatment for prescription drug abuse and heroin use, the presidential memorandum directs federal departments and agencies that directly provide, contract to provide, reimburse for, or otherwise facilitate access to health benefits, to conduct a review to identify barriers to medication-assisted treatment for opioid use disorders and develop action plans to address these barriers.
The White House will host a Champions of Change event this spring to highlight individuals in communities across the country who are leading the fight to respond to prescription drug abuse and heroin use.
Additional Federal Actions
U.S. Department of Justice
- The Drug Enforcement Administration (DEA) announced that it will continue its National Prescription Drug Take-Back Day program events in the spring and fall of 2016. As the president highlighted in a recent weekly address, Take-Back Day aims to provide a safe, convenient, and responsible means of disposing of unused prescription drugs, while educating the public about the dangers of misusing medications. DEA also finalized a new rule making it easier for communities to establish ongoing drug take-back programs. Read more about the DEA’s drug disposal information.
U.S. Department of Health and Human Services (HHS)
- The Department of Health and Human Services (HHS) will undertake a review of how pain management is evaluated by patient satisfaction surveys used by hospitals and other health care providers, including review of how the questions these surveys use to assess pain management may relate to pain management practices and opioid prescribing. HHS also launched this site as a one-stop federal resource with tools and information for families, health care providers, law enforcement, and other stakeholders on prescription drug abuse and heroin use prevention, treatment, and response.
- The Centers for Disease Control and Prevention (CDC) will invest $8.5 million on the development of tools and resources to help inform prescribers about appropriate opioid prescribing; track data on prescribing trends; research, develop, and evaluate clinical quality improvement measures and programs on opioid prescribing; and improve public understanding of the risks and benefits of opioid use. U.S. Surgeon General Vivek Murthy is developing an education campaign for doctors, dentists and other health care professionals who prescribe opioid pain medications. Earlier this month, Murthy also announced that work has begun on the first-ever surgeon general's report on substance use, addiction and health scheduled for publication in 2016.
- Centers for Medicare and Medicaid Services (CMS) will release an information bulletin to states by the end of the year on steps states can take through their Medicaid preferred drug lists (PDLs) and other utilization management mechanisms to reduce the risk of overdose. This includes a recommendation that they consider removing methadone from their PDLs for pain management. The Centers for Disease Control and Prevention has found that the use of methadone in pain treatment is associated with a disproportionately high number of overdose deaths compared to other opioid pain relievers. This fall, CMS is testing three new Medicare prescription drug plan measures designed to identify potential opioid overutilization, with the goal of proposing publicly reportable measures for Part D drug plans next year. These measures are based on the work of the Pharmacy Quality Alliance.
The Department of Veterans Affairs
- The Department of Veterans Affairs will lead a research initiative to evaluate non-opioid alternative approaches to pain management. The Department of Defense (DoD) and VA are developing a standardized pain management curriculum for widespread use in education and training programs.
The Bureau of Indian Affairs (BIA) and the Indian Health Service
- The Bureau of Indian Affairs (BIA) and the Indian Health Service (IHS)will provide BIA police officers and investigators the overdose reversal drug naloxone and training on its use. In 2016, the BIA, through the United States Indian Police Academy, will provide training to all BIA and tribal police officer cadets in recognizing opioid use disorders and overdose symptoms.
Moving Forward
In 2010, the president released his first National Drug Control Strategy, emphasizing the need for action to address opioid use disorders and overdose, while ensuring that individuals with pain receive safe, effective treatment. The next year, the White House released its national Prescription Drug Abuse Prevention Plan to outline its goals for addressing prescription drug abuse and overdose. This year the administration, through the CDC, launched the Prescription Drug Overdose: Prevention for States Program.
Prescription Drug Overdose: Prevention for States Program
The program provided $20 million to states to support strategies to improve prescribing practices and prevent opioid overdose deaths. Through a competitive application process, CDC selected 16 states to receive funds through the program: Arizona, California, Illinois, Kentucky, Nebraska, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont and Wisconsin.
Over the next four years, CDC plans to give states annual awards between $750,000 and $1 million each year, subject to the availability of funds, to advance prevention, including in these areas:
- Enhancing prescription drug monitoring programs (PDMPs).
- Putting prevention into action in communities nationwide and encouraging education of providers and patients about the risk of prescription drug overdose.
- Working with health systems, insurers, and professional providers to help them make informed decisions about prescribing pain medication.
- Responding to new and emerging drug overdose issues through innovative projects, including developing new surveillance systems or communications campaigns.
States can also use the funding to better understand and respond to the increase in heroin overdose deaths and investigate the connection between prescription opioid abuse and heroin use.
The president's budget for 2016 includes a request from HHS Secretary Sylvia Mathews Burwell for the resources needed to expand CDC’s state efforts to all 50 states and launch a national program that will focus on prevention and prescription drug overdose surveillance.
Additional Resources
- The Department of Health and Human Services:
- Opioids: The Prescription Drug & Heroin Overdose Epidemic
- The Centers for Disease Control and Prevention (CDC) Vitalsigns: Todays Heroin Epidemic
- CDC Documents: State Laws on Prescription Drug Misuse and Abuse
- Substance Abuse and Mental Health Services Administration’s (SAMHSA) Partnerships with State, Territory, County, and Other Governmental Organizations
- SAMHSA Grants to States
- National Survey on Drug Use and Health
