CDC Taking Steps to Combat Opioid Deaths

Ileana Arias, Ph.D.: "We all need to be bound together in the effort to address opioid abuse and overdose deaths if we are going to be successful."

Ileana Arias, Ph.D.: “We all need to be bound together in the effort to address opioid abuse and overdose deaths if we are going to be successful.”

The Centers for Disease Control and Prevention (CDC) estimates that enough opioids were sold in 2010 to give every American adult a 5 mg Vicodin tablet every four hours for a month.

That startling statement by Ileana Arias, Ph.D., Principal Deputy Director of the CDC and the Agency for Toxic Substances & Disease Registry, brought a collective gasp from Saturday’s Policy Plenary audience.

During “Addressing Prescription Drug Abuse: Role of the Physician in Counteracting Diversion, Misuse, and Addiction,” she looked at the impact of drug overdose deaths involving opioids, drivers for abuse, and CDC policy recommendations.

Calling interest in opioid abuse and death unprecedented in its momentum, Dr. Arias says its degree of urgency and multidimensional nature requires that various sectors have an appropriate role.

“We all need to be bound together in the effort to address opioid abuse and overdose deaths if we are going to be successful,” she says.

Heart disease and cancer are the leading causes of death for all Americans, according the CDC. However, unintentional injury surpassed motor vehicle crashes as the leading cause of death for young Americans (birth to age 34 or 45, depending on surveillance year) in 2008.

In overdose deaths where a drug was specified, according to the CDC, nearly 75 percent involved prescription drugs. Of those deaths, opioid pain relievers were the cause of almost 75 percent. In 2009, more than 15,000 people died from overdoses involving opioid pain relievers.

Faced with an overabundance of supply of these powerful drugs, the misuse and abuse of the medications, and high economic costs, which are estimated to cost insurers $72.5 billion every year, the CDC sought to determine portals of accessibility that lead to misuse and overdose.

Those areas are pill mills: prescribers who have not been trained in appropriate pain management or addiction; Emergency Department and hospital prescribers who are unaware of patient prescription histories; pharmacies that fail to determine if they are dispensing legitimate prescriptions and do not identify patients who pharmacy shop; insurer and pharmacy benefit managers who manage prescriptions; ill-informed patients and the public (one study found 70 percent of people who use pain relievers nonmedically acquired them from a friend or relative); and people at high risk for overdose.

The CDC is responding in several ways, including through continuous support and development of surveillance systems at the federal, state, and local levels to identify problems early and respond in a timely manner. The organization also seeks to provide appropriate public, patient, and professional education about the risk and appropriate use of opioids as means to change practice.

To gain momentum, the CDC also is looking to several efforts, including prescription drug monitoring programs; patient review and restriction programs; laws, regulations and policies; insurers and pharmacy benefit manager mechanisms; and clinical guidelines.

Not only are these powerful and fast-acting, they also are relatively cheap compared to other more traditional public health interventions and efficient, Dr. Arias says.

“The CDC essentially is bringing science to prevention and informed policy to achieve population change,” Dr. Arias says. “We can’t do it alone. I thank you for your efforts and partnership, and I am more than interested in your feedback—suggestions you may have for what it is that the CDC, specifically public health, can add to the effort and then learning from you about potential avenues to pursue.”

What did you think of Saturday’s Policy Plenary Session?Martin“I’m incredibly pleased that the CDC is taking the leadership on this. The points they made are on target. It is interesting to see ASAM practitioners, who have followed these principles for years, and now suddenly it is becoming governmental policy.”Patrick Martin, M.D.
Wilmington, N.C


Chiarottino“I thought it was biased toward the enforcement side of the problem. I agree there is a huge problem with availability and overprescribing, but there was very little mention of treatment. In California, the drug enforcement agency and state medical board are applying pressure on us to limit the problem when patients who need treatment and want it can’t get it.”

Michael Chiarottino, M.D., FASAM
Mill Valley Calif.

Ahmad“This was an excellent session and it’s great input to see the CDC’s leadership is giving us. There were some great questions about seeing more regulations put in for opioid prescriptions to make them more readily available.”

Seeme Ahmad, M.D.
Tucker, Ga.

Gordon“It is the best collaboration I have seen between federal agencies involved in issues of addiction and our medical society. It generated discussion of the issues and I think there is a real interest in working together. I suggested that we need to adopt a new paradigm that everybody is inspecting this problem though the same lens, and that lens would be the war on addiction as opposed to the war on drugs.”

Michael Gordon, M.D.

Lee“It was interesting to hear about addressing the epidemic of prescription drug overdose. It is something the public needs to learn about, and I think the Deputy Director did a great job giving an overall picture of the problem and ways it can be addressed.”

Jinhee J. Lee, Pharm.D.
Rockville, Md.

Jacobs“I’m glad to see the CDC is taking an interest. I hope they continue to move forward with publicizing the opioid epidemic we have in this country. I hope they will continue to work to help us get patients to treatment. It’s such a horrific problem that we need to publicize it and treat it the way we did the AIDS epidemic.”

William S. Jacobs, M.D.
Jacksonville, Fla.