Question of the Week
April 30, 2012
How is the CDC taking steps to combat opioid deaths?
The Tennessee Poison Center is one of the surveillance systems that collects the data on prescription drug abuse through the RADARS (Research, Abuse, Diversion, & Addiction Related Surveillance) program. This program provides data regarding prescription drug abuse (in the state of Tennessee and nationally) to policy makers and public health officials.
CDC TAKING STEPS TO COMBAT OPIOID DEATHS
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.”
This question prepared by: Donna Seger, MD Medical Toxicologist