By R Carter
On September 6, 2019 the CDC published updated data on it’s Injury Prevention and Control website and the major takeaway is that drug overdose deaths are continuing to rise.
The CDC reports that drug overdose deaths continue to impact communities in the United States. From 1999 to 2017, more than 702,000 people died from a drug overdose. In 2017, more than 70,000 people died from drug overdoses, making it a leading cause of injury-related death in the United States.
In reporting on this topic one of the things that continues to surprise me is the ever creative ways this agencies goes about reporting on the subject. They always seem to find a way of dramatizing facts that if carefully looked at, are cleverly over dramatized. For example, in years past it was total number of pills prescribed, in this current report the CDC is now reporting on number of prescriptions written per 100 persons. With the overall total prescription rate down 30%, this is a clever way of inflating something which really isn’t inflated. They do this by not disclosing the fact that with chronic pain patients, many are prescribed two medications, one extended release formulation and the other a short acting one. By not reporting on daily morphine milliequivalents prescribed, they make it seem like more people are being prescribed opiates when in fact, they are not, many are receiving two scripts limited to a daily amount between 30-90 MME with the average being around 50 MME.
What has changed is the context in which the CDC is reporting this data. Up until early 2019 the overdose crisis was consistently reported as a prescription opioid crisis, that being consistent with the CDC’s embarrassing and botched release of opioid prescribing guidelines for chronic pain. There never has been a clear and unmistakable set of dotted lines between prescription opioids and opioid overdose deaths. Yet the CDC’s position resulted in no distinction made between street addicts and chronic pain patients. All but a handful of physicians I spoke with over the last five years, remained skeptical of blaming these events on prescription opioids. And those who did more often than not, came from academic roots not clinical roots. Most would agree, prescriptions opioids have played a part but to what degree, has never been clearly defined, documented or proven.
Prior to 2012, lacking proper oversight, monitoring and policing by the DEA, small scattered individuals, primarily private practice physicians, over prescribed massive amounts of opioids contributing to the problem. Its now clearly evident, following the release of DEA pill data from the Washington Post, that the agency was otherwise engaged. allowing a small number of unscrupulous doctors to abuse the public trust placed in them. That combined with an enterprising black market, set the stage for the opioid crisis we see today.
Now that prescribing is under control and with drug overdose deaths continuing to rise, the CDC has changed its tone when reporting on the phenomena, as they did in this current post showing that sixty-eight percent of the 70,000 deaths which occurred in 2017, involved prescription or illicit opioids.
What’s new is the acknowledgement that opioid overdoses are a result of illicit opioid use, not just prescription opioids. Without saying so, this is obviously a great embarrassment to the agency after publishing guidelines which categorically pinned the blame squarely on over prescribing by doctors.
If the overdose trend continues as it has into 2020, there will now be five years of data showing at least a 30% reduction in prescribing, more so in some parts of the country, in the face of opioid deaths which continue to set new records each year.
Obviously this can’t be an over prescribing problem, so no longer able to lay the blame on doctors, the CDC now makes their recommendation within the context of both illegal drug use as well as medical use, which is how it should have been from the beginning.
Such an embarrassment makes one wonder, how much science and research data actually guides the CDC when taking a position.