What the CDC Can Learn From Utah
Opioid Overdoses Increase Despite CDC’s Efforts
Everyone can agree on a few things. First, we have an opioid epidemic. Second, we want to mitigate it. Third, the efforts we’ve seen at the national level to ameliorate the crisis are not working.
As USA Today recently reported, the opioid epidemic is getting worse instead of better. Two top-level public officials — Dr. Debra Houry, Director of the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control and Dr. Francis Collins, Director of the National Institutes of Health — agree that whatever we’re doing to fix the epidemic doesn’t seem to be working. The amount of opioids prescribed has been declining for 5 years, but the number of overdoses has been increasing. So why are we not making progress?
When the CDC drafted and published the CDC Guideline for Prescribing Opioids for Chronic Pain in March 2016, its intention was to “ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.”
In September of this year, the CDC launched an advertising campaign, RX Awareness, that includes billboards, videos, social networking memes, newspaper ads, and radio spots to enhance its efforts.
Public Health Officials Not Optimistic About the RX Awareness Campaign
As Pain News Network points out, the messages focus solely on prescription opioids and don’t address illicit opioids, including fentanyl and heroin, “because the CDC didn’t want to risk ‘diluting’ its primary message.”
According to Pacific Standard, public health officials aren’t feeling optimistic that the RX Awareness campaign will help even the prescription opioid problem. Pacific Standard reports, “Everyone pointed to the same fatal flaw: The ads tell viewers that prescription opioids are a big problem, but don’t tell them what steps to take.”
So what can the CDC do to achieve better results? It may be helpful to examine the outcome of a similar campaign that began about a decade ago.
Utah-Based LifeSource Foundation Reduces Harm From Opioids
Utah was one of the top 10 states with the highest rate of unintentional prescription drug overdoses in 2006. That year, I founded a Utah-based non-profit organization called LifeSource Foundation. We launched an educational program called “Zero Unintentional Deaths ” to teach physicians, nurse practitioners, and physician assistants how to prevent opioid overdoses.
As part of the campaign, we created and distributed 6 — which were later updated to 8 — principles for safer prescribing and safe use of opioids. These principles, to some degree, overlapped with the CDC Guideline for Prescribing Opioids.
Despite their similarities, there were key differences in the CDC’s and Utah’s approaches to reducing harm from opioids. The most important of these differences was that Utah’s campaign included an educational program for providers describing how to more safely use opioids rather than advising them to limit doses. The CDC’s campaign primarily tells healthcare professionals to limit opioid prescribing rather than teaching them how to use opioids more carefully. The Utah campaign initially also included 6 principles for patients to follow which the CDC program lacks.
The LifeSource Foundation and UDOH’s goal, when it launched the “Use Only As Directed” campaign, was to decrease the number of unintentional opioid-related deaths by 15%, but it did better than that. By 2012, unintentional opioid-related deaths in Utah had decreased by nearly 30%.
What the CDC Might Learn from Utah’s “Use Only As Directed” Campaign
Things were different then. The Utah campaign occurred during a time when prescription opioids were causing the most harm. Methadone was disproportionately responsible for the overdose deaths. Illicitly manufactured and smuggled fentanyl hadn’t yet emerged as a major issue, and heroin seemed to be a problem of the past.
Today, there are more deaths from illicit opioids than prescription opioids, but the CDC’s program does not seem to take that into account. Therefore, the CDC is missing the major affected demographic when it focuses on prescription opioids rather than illicit opioids.
Utah’s attempts to mitigate the problem represents a grassroots, community-based program that was successful because it addressed the major source of the problem at the time and was evidence based. Unfortunately, Utah did not sustain its improvement in the number of overdose deaths. In fact, that figure recently reached an all-time high. The lessons of the “Use Only As Directed” campaign faded once the PSAs and physician education were discontinued and the problem evolved to include more illicit drugs than prescription opioids.
The CDC has resources that could make a difference. It’s uniquely positioned to succeed if it also addresses the major source of the problem: illicit drugs. Let’s hope the CDC recognizes this and makes the appropriate adjustments. And let’s trust they can do this without sacrificing the welfare of pain patients who benefit from prescription opioids.
Thank you for posting this article. As someone who lives with chronic pain, I know first hand that the CDC Guidelines has done a great disservice to CPPs due to its focus being solely on prescriptions meds. As you pointed out, prescription opioids are no longer driving the “epidemic” but those in need of them are facing scorn from the public at large in addition to having their meds tapered or completely discontinued altogether. Pain Management specialists are leaving their practices. People are being thrown into cold turkey withdrawal – a torturous process that can actually kill. Some are being forced into disability after being functional for years due to their meds. Others are taking their own lives as the pain returns and overwhelms them. Meanwhile, the CDC Guidelines are continuing to gain momentum by a government that just wants to say they got something done.
Thanks for the article, Dr. Webster. I would echo Sarafino’s observations and add a couple of insights if I may.
The National Institutes on Drug Abuse inform us that 90% of all addicts begin abusing drugs and alcohol in their teens. However, it is unusual for people of this age to be seen by a doctor for treatment of pain severe enough to warrant prescription of opioid analgesics for more than a few days. Addiction almost never happens on such short exposure. We are therefore led to the insight that managed prescription of opioids to people in agony is NOT the source of our current addiction crisis.
It is often pointed out that as many as 80% of addicts report their first exposure to opioids was to prescription pills. But there is something vital missing from such reports: Young people buy their drugs on the street. The drugs GET to the street by diversion and theft, not as a consequence of actual doctor appointments.
The current series by 60 Minutes and the Washington Post on Congressional collusion with drug distribution companies has completely missed this nuance. Their focus is on the misbehavior of drug distributors and the bribery of Congressmen — and this is probably a need focus. But it isn’t the whole story. Chronic pain patients are suffering for the carelessness of this reporting, by being cut off from medications that sustain the quality of their lives. The series is encouraging a massive witch hunt against the great majority of doctors who aren’t running pill mills.
We need to get this story right: the addiction crisis is real. It is aided and abetted by pharmaceutical companies and drug distributors who have bribed Congress. But addicts are only rarely pain patients when they start abusing. To lower addiction rates we have to intervene earlier in the cycle of aggressive marketing of stolen and illegal drugs to kids. And to reduce harm among addicts, we have to stop throwing them in prison and start reintegrating them into our communities.
Most of the resources of our so-called war on drugs are being wasted on policy that doesn’t work and never will. And pain patients are paying the price for that misdirection.
Our Government can take a look a what Holland did un the 70s, 80, 90s and so forth and so on. They legalize marijuana and it still is they don’t put people in jail that do illegal drugs they offer them rehabilitation it doesn’t do anyone any good to put people that are addicted to illegal drugs into prisons now if you want to put them into Rehabilitation if they want to be there to get off of illegal drugs great and that’s what Holland has done they built programs and offer them to their citizens that if they want to get off of these drugs and be rehabilitated they offer them programs to go to and as far as I know they’re free and why we can’t do that I haven’t a clue because we pay hundreds of thousands of dollars to put people in prison that we could turn around and certainly pay for Rehab just as easily as we could pay for prison systems and I think come out and turn the person around with far greater results then turn a person out of prison who has no rights and abilities to gain a job then someone who’s been rehab from drug abuse who has every chance in the world to go out there and get a job and that I really wish we would stop telling people you know that someone has a prison record so that they can’t get a job once they get out of prison you know why can’t we change that stupid law there’s just a lot of things that need to be changed about our legal system and why the hell we can’t do it because who’s in office and it’s not about Democrats and Republicans it’s about who is in office the actual person we are elect not the party it’s about the person so think about it people.