Insights on the Opioid Crisis: Analyzing CDC Data and Policy Recommendations
Delve into the complexities of the opioid crisis through an examination of CDC data depicting the relationship between opioid addiction and overdose deaths. Contrary to popular belief, the crisis is not solely attributed to physicians over-prescribing opioids. Gain a deeper understanding of who is prescribed opioids for pain, who succumbs to opioid overdose, and the misconceptions surrounding opioid addiction. Explore expert insights from Dr. Nora Volkow and the American Medical Association (AMA) highlighting the nuances of opioid prescribing guidelines and the implications for patient care and public health.
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The Opioid Crisis In Three Charts Prepared for Town Hall Meeting St Johns County Florida Richard A Lawhern PhD June 24, 2021
Purpose Review CDC Data That Demonstrate: The US public health problem with opioid addiction and overdose-related deaths is not caused by physicians over-prescribing to patients. And it never was. Suggest Changes of Policy Direction to Improve Outcomes
Who Dies from Opioid Overdose? Note: Full data set available on request: lawhern@hotmail.com
Observations from Dr Nora Volkow Director, NIDA Unlike tolerance and physical dependence, addiction is not a predictable result of opioid prescribing. Addiction occurs in only a small percentage of persons who are exposed to opioids even among those with pre-existing vulnerabilities. [Ref] Nora D Volkow, MD and Thomas A McLellan, Ph.D., Opioid Abuse in Chronic Pain Misconceptions and Mitigation Strategies . NEMJ 2016; 374:1253-1263 March 31, 2016]. http://www.nejm.org/doi/full/10.1056/NEJMra1507771
Observations of the AMA [ref] We can no longer afford to view increasing drug-related mortality through a prescription opioid-myopic lens Some patients with acute or chronic pain can benefit from taking prescription opioid analgesics at doses that may be greater than guidelines or thresholds put forward by federal agencies. A CDC Guideline only focused on opioid prescribing will perpetuate the fallacy that by restricting access to opioid analgesics, the nation s overdose and death epidemic will end. The CDC Guideline has been misapplied as a hard policy threshold by states, health plans, pharmacy chains, and PBMs. It is clear that the [2016] CDC Guideline has harmed many patients so much so that in 2019, the CDC authors and HHS issued long-overdue clarifications that states should not use the CDC Guideline to implement an arbitrary threshold.* (*emphasis by the author). [Ref] https://www.ama-assn.org/press-center/press-releases/ama- urges-cdc-revise-opioid-prescribing-guideline - June 17, 2020
Required Reading Lawhern RA. Revising the US CDC Guidelines on Opioid Prescription - A Commentary. Nursing and Primary Care, 2020; 4(6): 1-6. Satel, Sally, The Truth About Pain Killers National Affairs, Nr 47, Spring 2021 https://nationalaffairs.com/publications/detail/the-truth-about-painkillers Barnes, Michael C, A More Sensible Surge: Ending DOJ's Indiscriminate Raids of Healthcare Providers Legislation and Policy Brief, Vol 8: Iss 1, Article 3 https://digitalcommons.wcl.american.edu/cgi/viewcontent.cgi?article=1071&context=l pb Singer, Jeffrey A, If Lawmakers Really Want to Follow the Science They Will Repeal Codified Opioid Guidelines Cato At Liberty, May 24, 2021. https://www.cato.org/blog/lawmakers-really-want-follow-science-they-will-repeal- codified-opioid-guidelines Bloom, Josh, Comments to the FDA: Opioid Dosing Based on Milligram Morphine Equivalents Is Unscientific, American Council on Science and Health, May 24, 2021 https://www.acsh.org/news/2021/05/24/comments-fda-opioid-dosing-based-milligram- morphine-equivalents-unscientific-15561
Implications for St Johns County Public policy to address the opioid crisis must emphasize harms reduction, not limits on prescribing. Remove barriers to timely medication-assisted addiction treatment, including lack of nearby access Reduce disease and overdose risks in needle exchange programs Divert first-time non-violent drug offenders out of jail or prison. Transition newly released prisoners immediately into active community support (MINUTES, not days) Long term community programs needed Safe, sober housing Job training and labor force development Removing job application barriers Professionally staffed community counseling centers
About the Author Technically trained, non-physician subject matter expert on public policy for regulation of prescription opioids and physicians who prescribe 25 years experience, 30,000+ patient contacts moderating social media patient support groups for people in pain >125 published papers and articles Practical Pain Management, Journal of Medicine (US College of Physicians), Pain News Network, STAT News, others No financial or professional conflicts of interest
