This week I want to share two articles regarding the CDC and opioids. The first article is about a recent clarification to the CDC’s 2016 guideline for prescribing opioids that has become necessary due to how the guidelines have been used. The second article showcases provisional numbers that suggest drug overdose deaths will fall in 2018 for the first time in three decades. Below you’ll find these articles and my thoughts on their implications.
Disclaimer: The views and opinions expressed below are those of Mark Pew, Senior Vice President of Product Development and Marketing, and do not necessarily reflect the views of Preferred Medical.
In 2016 the CDC issued a guideline for prescribing opioids for chronic pain and this week they published clarification surrounding these initial guidelines. The clarification’s main point is that while the opioid crisis is in full effect across the US, the efforts to de-prescribe opioids and reduce the use for everyone has caused many people additional, unintended health risks. Sometimes, less opioids are not always the better decision. And opioids should never be discontinued without forethought. Each patient and their treatment should be customized to suit the needs of the individual.
“The assumption that ‘less opioids is always better, for everyone,’ is just as flawed as assuming that an opioid is right for everyone; absolutes in either direction confer risk.” Beth Darnall talks about how the CDC opioid guidelines in 2016 were “less controversial in content” but have sometimes been “misapplied”. The target is always a balance (“Appropriate, Not Zero, Opioids“) but nuance isn’t always our society’s strong suit when confronted with a complicated and difficult issue (as the evolving opioid epidemic was and continues to be). The “CDC clarified this critical point today: dose thresholds were designed only for the initiating of opioid therapy, and were never intended to justify forcing patients taking long-term opioids down to these thresholds, or being denied these medications at all.” It’s a red flag for me when somebody articulates a binary argument—it’s either true or false, yes or no—in the midst of a very complex circumstance. In the case of Rx opioids, the real answer is…it depends.
The CDC predicts that drug overdose deaths in the US will decline for the first time in decades. While the final number is still being determined, the data thus far shows that for the 12-month period ending in November 2018 there were 69,096 drug overdose deaths compared to 72,287 in the previous year. If this number is confirmed in a couple of months, the overdose death rate will drop for the first time since 1990.
This is good news about the (so far—the CDC is still counting) change in trajectory of drug overdose deaths. But it’s obviously not a victory when a projected 69,100 people will have died in 2018. And when you realize that Naloxone is likely a primary driver of the decline in deaths. Obviously, it’s a good thing to save people’s lives—we should do that at every opportunity. But reversing an overdose is treating the symptom and not the cause. My guess (based on what I’ve read and heard) is that the number of overdoses continues to increase thanks to the growing prevalence of illicit fentanyl and it’s analogues (“predicted 32,159 deaths from synthetic #opioids…up from the predicted 29,092 deaths… in 2017”). Here’s an example: At Bonnaroo a couple of weeks ago, local TV announced every member of law enforcement was going to have naloxone and there were standalone naloxone kiosks for attendees to access. The week prior there had been an outbreak in overdoses because the local marijuana had fentanyl in it. So now is not the time to pause but to press on. These are obviously national statistics. Changes are different in each state. For example, Ohio is trending towards a 23.3 percent decrease while Missouri has a 15.3 percent increase and New Jersey has a 11.6 percent increase. It’s important to keep both a macro and micro viewpoint because each have different strategies and tactics. And it’s important to realize that victory over this societal scourge is still on the horizon and not in our grasp…yet.
To read everything on my mind this past week, please visit me on LinkedIn at https://www.linkedin.com/pulse/marks-musings-july-1-mark-rxprofessor-pew/.
Until Next Week,