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Deb Houry, MD, MPHDirector, National Center for Injury Prevention and Control
CDC Guideline for Prescribing Opioids for Chronic Pain, 2016
Meeting of the Interagency Pain Research Coordinating CommitteeDecember 3, 2015
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Three Pillars ofCDC’s Work• Improve data quality and
track trends
• Strengthen state efforts by scaling up effective public health interventions
• Supply healthcare providers with resources to improve patient safety
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Drug overdose is the leading driver of rising midlife mortality• Increases in midlife drug
poisoning, liver disease, and suicide are persistent & large enough to drive up all-cause midlife mortality
• If non-Hispanic white mortality for ages 45-54 had continued declining at the 1979-1998 rates, half a million deaths would have been avoided in the past 15 years
Case & Deaton. Rising morbidity and mortality in midlife among white Non-Hispanic Americans in the 21st century. PNAS [epub Nov 2, 2015].Note: Poisonings include alcohol and Rx/illicit drugs.
Death rates from poisoning increased >4x among non-Hispanic whites
aged 44-54 between 1999 to 2013POISONINGS
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Opioid overdose deaths, sales, and treatment admissions rise in parallel
National Vital Statistics System, DEA’s Automation of Reports and Consolidated Orders System, SAMHSA’s TEDS
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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Rat
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Opioid Sales KG/10,000
Opioid Deaths/100,000
Opioid Treatment Admissions/10,000
Opioid Sales Kg/10,000
US, 1999-2010
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Death rates from heroin overdoseare increasing rapidly
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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
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CDC Vital Statistics
Heroin
Rx Opioids
All opioids (Heroin and Rx)
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3 out of 4 people reporting Rx opioid and heroin use in past year took Rx opioids first
Jones, C.M., Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002–2004 and 2008–2010. Drug Alcohol Depend. (2013).
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Half of US opioids market is for chronic, non-cancer pain
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JAMA 2011;305:1315-1321
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Current Guideline Landscape
• Gaps
o Incorporate new evidence
o Use rigorous processes
o Avoid conflicts of interest
o Focus on primary care
• Common Elements in Guidelines for Prescribing Opioids for Chronic Pain
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Guideline for Prescribing Opioids for Chronic Pain Primary care providers
Patients ≥18 with chronic pain
Outpatient settings
Not intended for patients undergoing active cancer treatment, palliative care, or end-of-life care
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LeveragingAHRQSystematicReview
Sept 2014
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Clinical Practices Addressedin the Guideline
• Determining when to initiate or continue opioids for chronic pain
• Opioid selection, dosage, duration, follow-up, and discontinuation
• Assessing risk and addressing harms of opioid use
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Draft guideline recommendations• Non-opioid therapy is preferred for chronic pain outside of
active cancer, palliative, and end-of-life care.
• When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose.
• Providers should always exercise caution when prescribing opioids and monitor all patients closely.
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For more information please contact Centers for Disease Control and Prevention
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Special thanks to Kristen Sanderson for her help preparing this presentation