The Centers for Disease Control and Prevention on Tuesday released new, long-awaited guidelines for prescribing opioid painkillers — the latest in an attempt to slow down the deadliest drug epidemic in US history.
"More than 40 Americans die each day from prescription opioid overdoses, we must act now," CDC Director Tom Frieden said in a statement. "Overprescribing opioids — largely for chronic pain — is a key driver of America’s drug-overdose epidemic. The guideline will give physicians and patients the information they need to make more informed decisions about treatment."
The CDC issued 12 recommendations for primary care providers, who account for nearly half of opioid prescriptions. The agency highlighted three of them:
- Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care.
- When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose.
- Providers should always exercise caution when prescribing opioids and monitor all patients closely.
The idea is to encourage doctors to be more cautious about prescribing opioids, making them less likely to distribute the drugs to patients who are prone to addiction or don't really need the medication. (The evidence on whether opioid painkillers can even treat chronic pain is weak at best.) And if doctors take up the recommendations, they could help stop one of the deadliest drug epidemics in US history.
The CDC's recommendations are the latest attempt to stop the opioid epidemic
As Frieden mentioned, this is all aimed at stopping a very deadly drug epidemic. In 2014, more than 47,000 people in the US — a new record — died of drug overdoses, according to federal data published in January. Nearly 19,000 of those deaths were linked to opioid painkillers, making them a cause in 40 percent of overdose deaths.
The CDC's recommendations are just the latest among several changes by the federal government to slow the overdose death toll.
For example, in 2014 the Drug Enforcement Administration reclassified some opioid painkillers from schedule 3 to the more restrictive schedule 2, limiting access for both patients and doctors.
The Obama administration has also stepped up general spending on treatment and prevention programs over the past few years. It dedicated $2.5 million in 2015 to fight heroin abuse. The Department of Health and Human Services set aside $133 million in 2015 to fight opioid abuse. And the administration helped launch a combination of federal, state, local, and private efforts in 2015 to provide better prescriber training and improve access to addiction treatment, including medication-assisted treatment.
The Obama administration also recently proposed further steps, including more funding for treatment programs. And Congress is currently considering several bills, including a Senate-passed measure, to provide more funding to address the epidemic.
There's a risk to the CDC's recommendations
One big risk to the CDC's prescription guidelines: They could push some patients to deadlier opioids.
Over the past several years, doctors have responded to the epidemic and government pressure to pull back on opioid prescriptions by, well, pulling back opioid prescriptions.
But the new restrictions left a lot of patients without a drug that they were still very much addicted to. So instead of quitting opioids altogether, some patients turned to deadlier but often cheaper and more accessible opioids like heroin and fentanyl. The CDC in 2015 found that people who are addicted to prescription painkillers are 40 times as likely to be addicted to heroin. And in 2014, more than 10,000 overdose deaths were linked to heroin — a 500 percent increase from 2000.
This doesn't necessarily mean that restricting access to opioids is or was a bad idea. By limiting access to the drugs, public health officials and doctors were able to prevent the creation of a new generation of addicts, potentially saving a lot of lives in the long term.
But it did leave a lot of opioid-addicted patients stranded for now. So different levels of government are now stepping up efforts to improve access to care. Whether access is improved enough could decide whether policies like the CDC prescription guidelines will save lives — by stopping a new generation of addicts — or lead to more overdose deaths — by leaving a lot of people addicted and stranded without care, pushing them to resort to deadlier drugs.