In 2016 as part of the urgent response to the epidemic of opioid overdose deaths, the CDC issued new recommendations for prescribing opioid medications for chronic pain, excluding cancer, palliative, and end-of-life care. While not law or regulations which carry the weight of law, the CDC guidelines have been widely adopted by state medical boards and implemented by regulation with the force of law. The word guideline(s) is used 173 times throughout the publication. the word recommend or recommendation is used 237 times, the word should 227 times, and the word taper or tapering 58 times.
Despite these cautionary words, practitioners, hospitals, and clinics abruptly terminated patient medications resulting in a rash of suicides across the U.S. with the last reported count being in excess 1,500 deaths in 2018, and they experimented in performing surgeries without the use of opioids for post-op pain management. Due to these rash actions, the CDC had to issue an erratum revision of the guidelines stressing that the guidelines were for general practitioners treating chronic pain not acute pain. The erratum provided guidelines for a staged reduction with frequent reassessments of the patient's condition. As of 2020 it's estimated that more than 1,000,000 individuals are no longer employed, forced into lower-paying jobs, onto welfare rolls, or into early retirement on reduced Social Security Benefits do to these actions. With the number of prescriptions written now down by more than 33% the overdose death rate continues to climb.
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Prologue by R Carter: Prescription Drug Monitoring Programs (PDMP) have been active in most states since around 2010. They are an outgrowth of the need to collect definitive data on the prescribing practices of physicians in the face of a national opioid overdose crisis. Prior to 2011 the only reliable data public health officials had, was the growing number of opioid prescriptions and the number of overdose deaths reported in our national vital statistics system. What happened in between these two events was a black box, an unknown that frightened public health officials enough to justify both the rational motivation to take corrective action as well as fuel the opioid hysteria that continues as of 2020.
At a total cost greater than $500 billion over ten years, the question as to their success in reversing the opioid overdose crisis is still unclear. While it’s assumed these programs have had some benefit, only one state out of 50 has published any data confirming or denying the contribution of prescribed opioids in the so-called prescription opioid crisis, and that number was astonishingly low, just 1.3%. Massachusetts published a report from 2013 – 2015 that showed the following results.
Of 2916 decedents with complete toxicology reports, 1789 (61.4%) had heroin and 1322 (45.3%) had fentanyl detected in postmortem toxicology reports. Of the 491 (16.8%) decedents with ≥1 opioid prescription active on the date of death, prescribed opioids were commonly not detected in toxicology reports, specifically: buprenorphine (56 of 97; 57.7%), oxycodone (93 of 176; 52.8%), and methadone prescribed for opioid use disorder (36 of 112; 32.1%). Only 39 (1.3%) decedents had an active prescription for each opioid detected in toxicology reports on the date of death.
Julie O’Donnell, PhD1; R. Matt Gladden, PhD1; Bruce A. Goldberger, PhD2; Christine L. Mattson, PhD1; Mbabazi Kariisa, PhD1 (View author affiliations)
Approximately two-thirds of the 70,237 U.S. drug overdose deaths reported in 2017 involved opioids (1). Since 2013, opioid-involved overdose deaths involving illicitly manufactured fentanyl has sharply increased (1,2). Fentanyl analogs are structurally similar to fentanyl but vary in potency, are primarily illicitly distributed, and require specific postmortem toxicology testing for detection.* Deaths involving fentanyl analogs, particularly carfentanil, increased in 10 states during 2016–2017 and often co-occurred with fentanyl (3). CDC funded 32 states and the District of Columbia (DC) to enhance postmortem toxicology testing and abstract data from death certificates and medical examiner and coroner reports on opioid-involved overdose deaths of unintentional and undetermined intent through the State Unintentional Drug Overdose Reporting System (SUDORS).† Twelve states have collected data since July 2016, and an additional 20 states and DC began collecting data in July 2017 as part of a rapid expansion of SUDORS. This analysis 1) reports rapid changes in opioid-involved overdose deaths with fentanyl§ and fentanyl analogs detected during July 2016–December 2018 among 10 states with available SUDORS data¶ and 2) provides a description of the most recent data on deaths with fentanyl and fentanyl analogs detected among 28 states and DC.** Tracking specific drugs involved in overdose deaths is critical because the risk for overdose for fentanyl and fentanyl analogs varies substantially. There are considerable differences in potency, dose, purity, and co-use patterns among drug products.††