With the death of Prince from an overdose of the narcotic Fentanyl, another celebrity becomes a statistic in the opioid drug overdose epidemic, currently gripping the United States.  This epidemic is responsible for nearly half a million deaths between 2000 to 2014, according to the Centers for Disease Control and Prevention (CDC).  Increases in prescription opioid analgesics and heroin deaths are thought to be the forces fueling the epidemic.

Opioid Use – A Dangerous Trend

Since 2000, the CDC reports a 200% increase in the rate of overdose deaths related to the use of opioid pain relievers and heroin, the main drugs associated with overdose deaths.  During that time period, death rates from opioid overdoses increased significantly for both sexes, in persons aged 25–44 years and those older than 55 years of age.  The states of West Virginia, Ohio, Kentucky, New Mexico and New Hampshire are the most affected.

Natural and semisynthetic opioids, which include the most commonly prescribed opioid pain relievers, oxycodone and hydrocodone, continue to be involved in more overdose deaths than any other opioid type.  One component of opioid overdoses is believed to involve illicitly-made fentanyl, a short-acting opioid.

Heroin-related deaths increased in recent years.  A history of misuse of prescription opioids is the strongest risk factor for heroin initiation and use.  Increased availability of heroin, its relatively low price compared to prescription opioids and high purity appear to be major drivers of the upward trend in heroin use, overdoses, and deaths.

New Guidelines

On March 15, 2016, just weeks before Prince’s death, the CDC released its Guideline for Prescribing Opioids for Chronic Pain – United States 2016The guideline was developed to assist primary care providers in ensuring the safest and most effective treatment for their patients with chronic pain which is not related to active cancer treatment, palliative and end-of-life care.

The guideline presents twelve recommendations for providers who manage chronic pain patients.  Arguably, the most important guideline recommendation is the endorsement of nonopioid therapy as the preferred method of dealing with chronic pain.  The use of opioids should be limited to situations when the benefits for alleviating pain and improving function outweigh the risks of opioid use.  And when opioid analgesics are prescribed, it is recommended that providers prescribe the lowest dose found to be an effective treatment of an individual’s pain.  Frequent follow-up and evaluation of the drug treatment plan is suggested.  The guideline encourages the provider to become a partner with the patient in developing treatment goals and outline how the opioids will be discontinued if no benefit is achieved.  The CDC Guideline can be accessed at http://www.cdc.gov/drugoverdose/prescribing/guideline.html.

If you or someone you know suffers from an opioid addiction, please consider contacting SAMHSA’s National Helpline for help or reach out to the National Institute on Drug Abuse.

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