HORRIFIC AS it is for the victims, drug addiction’s impact reverberates beyond them, to include families, friends, whole communities. Thanks to a new Washington Post-University of Maryland poll, we can begin to quantify those wider consequences in our area. Nearly 3 in 10 Marylanders say they have a close friend or family member who was or is addicted to opiates such as prescription pain pills or heroin. The figures range from 4 in 10 in Baltimore to 1 in 6 in Montgomery County; but whether in the city or the suburbs, these numbers are far too high and fully warrant Gov. Larry Hogan’s (R) promise to focus on the problem.
More treatment is necessary, as is prevention; yet preventing opioid addiction has been devilishly difficult due to the fact that people’s first contact with the drugs often comes not through illicit channels but in a doctor’s office, where they are prescribed opioids by a licensed physician who, in turn, had been told that medications such as OxyContin or Vicodin convey powerful relief with little or no addiction risk. In 2012, providers wrote 259 million prescriptions for opioids, enough for every American adult to have a bottle of pills. Opioid sales increased 300 percent since 1999. Almost 2 million people abused these drugs in 2013, and more than 16,000 died from overdoses.
Now the Centers for Disease Control and Prevention (the source of these data) has a plan that could make a major dent in the overprescription of opioids. The CDC is preparing opioid prescribing guidelines for primary-care physicians — the first of their kind from a federal agency. The guidelines are not finished, but early indications are that they will urge physicians to discuss risks with patients, pursue non-opioid alternatives as “preferred” options and limit initial prescriptions to a three-day supply at “the lowest effective dose.” If finalized by the CDC and embraced by doctors, the guidelines promise to turn medical practice in an appropriately more cautious direction.
As is often the case with suggestions to curb pain prescriptions, the CDC’s proposals are being met with opposition: some from people concerned about the impact on patients, some from a pharmaceutical industry concerned about the impact on profits. The American Cancer Society’s lobbying arm has urged the CDC to suspend work on its guidelines, arguing in an Oct. 1 letter to the agency that cancer patients could be denied pain relief. Though understandable, these concerns are overstated; the CDC has said publicly its focus is not oncology but primary care, “outside end-of-life care.”
It’s true, as the cancer society letter notes, that the CDC guidelines are more than mere suggestions and will influence “state health departments, professional licensing bodies or insurers.” That is precisely why they can be so beneficial; until now, government, medicine and the private sector have too often underestimated the risks, individual and societal, of widespread opioid prescription. The CDC has the prestige and authority to correct the balance. After incorporating valid comments from the cancer society and other interested parties, the CDC plans to publish in early 2016, and we see no reason to delay.