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As opioid deaths reach record high, drug industry resists efforts to rein in prescriptions

Minnesota experienced essentially no change in its drug overdose deaths. The state had 523  in 2013 and 517 in 2014, according to the CDC’s data.

Six out of 10 overdose deaths in 2014 — 28,647 — involved opioids, either prescription opioids, such as OxyContin, Viocodin or Percocet, or heroin.Creative Commons/johnofhammondSix out of 10 overdose deaths in 2014 — 28,647 — involved opioids, either prescription opioids, such as OxyContin, Viocodin or Percocet, or heroin.

In 2014, the number of people who died from drug overdoses in the United States reached 47,055 — an all-time high, according to a disturbing report published Friday by the Centers for Disease Control and Prevention (CDC).

In fact, about 1½ times more people died of a drug overdose in the United States in 2014 than died in motor vehicle accidents.

The increase in drug overdose deaths was observed in a wide range of demographic groups: men and women, blacks and whites, and adults of almost all ages.

The number of overdose deaths in the Midwest jumped 9.6 percent in 2014 — the highest increase of any region in the country. Minnesota, however, experienced essentially no change in its numbers. The state had 523 drug overdose deaths in 2013 and 517 in 2014, according to the CDC’s data.

A continuing epidemic

The report makes it clear that the opioid epidemic of the past decade is continuing unabated. Six out of 10 overdose deaths in 2014 — 28,647 — involved opioids, either prescription opioids — such as OxyContin, Viocodin or Percocet — or heroin.

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Deaths from prescription opioids jumped 9 percent in 2014, but deaths from heroin and from fentanyl, an opioid often made illicitly and added to or sold with heroin, are also rising.

Since 2000, overdoses from all these opioids have quadrupled, the report noted.

“The increasing number of deaths from opioid overdose is alarming,” said CDC Director Dr. Tom Frieden in a released statement. “The opioid epidemic is devastating American families and communities. To curb these trends and save lives, we must help prevent addiction and provide support and treatment to those who suffer from opioid use disorders. This report also shows how important it is that law enforcement intensify efforts to reduce the availability of heroin, illegal fentanyl, and other illegal opioids.”

Pushback from the drug industry

The report calls for “intensified” efforts to encourage physicians and other health professionals to be safer about prescribing opioid medications. One of those efforts has been the development by the CDC of proposed new guidelines for the prescribing of opioids to patients with chronic pain. The draft guidelines were shared via webinars with several hundred participants earlier this fall, and were officially published last week in the Federal Register

The CDC experts who wrote the guidelines reviewed more than 100 studies on the medical use of opioids — drugs that were originally developed to relieve the pain of people with late-stage cancer. Indeed, as I’ve noted here before, most states used to prohibit physicians from prescribing opioids to patients with non-cancer chronic pain — until the late 1990s, that is. That’s when the pharmaceutical industry successfully lobbied state legislatures to liberalize opioid use to include the treatment of common chronic conditions, such as low back pain, headaches and fibromylagia. Physicians and patient advocacy groups with strong financial ties to opioid manufacturers helped greatly with that lobbying effort.

Sales jumped to more than $9 billion a year. Deaths from opioid overdoses also climbed — to their current tragic heights.

But, as AP reporter Matthew Perone reported over the weekend, the effort to get physicians to curb their prescribing of these drugs “may be faltering amid stiff resistance from drugmakers, industry-funded groups and, now, even other public health officials.”

“Under the proposed guidelines [which are non-binding],” writes Perone, “doctors would prescribe these drugs only as a last choice for chronic pain, after non-opioid pain relievers, physical therapy and other options. The CDC also wants doctors to prescribe the smallest supply of the drugs possible, usually three days or less for acute pain. And doctors would only continue prescribing the drugs if patients show significant improvement.”

The pushback against the guidelines has been fierce. Writes Perone:

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Critics complained the CDC guidelines went too far and had mostly been written behind closed doors. One group threatened to sue. Then earlier this month, officials from the FDA and other health agencies at a meeting of pain experts bashed the guidelines as “shortsighted,” relying on “low-quality evidence.” They said they planned to file a formal complaint.

The CDC a week later abandoned its January target date, instead opening the guidelines to public comment for 30 days and additional changes.

Anti-addiction activists worry the delay could scuttle the guidelines entirely.

“This is a big win for the opioid lobby,” said Andrew Kolodny, cofounder of Physicians for Responsible Opioid Prescribing, a group working to reduce painkiller prescribing.

You can read more about the CDC’s proposed opioid prescription guidelines on the agency’s website. You’ll find the new report on drug overdose deaths in the Dec. 18 edition of the agency’s Morbidity and Mortality Weekly Report (MMWR).