Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations
The final report from the Task Force, authored by 29 experts from across government and medicine, includes a comprehensive set of recommendations on a myriad of issues regarding acute and chronic pain treatment, and most importantly, emphasizes the need for comprehensive, multidisciplinary and multimodal approaches to treating pain.
U.S. Department of Health and Human Services (2019, May). Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations.
Drug Overdose Deaths Involving Fentanyl, 2011–2016
A report from the CDC illustrates the rise in drug overdose deaths involving fentanyl from 2011 through 2016 nationally, and by age, sex, race and ethnicity, and public health region. The CDC’s research shows a 113 percent average annual increase from 2013 to 2016 (when adjusted for age). While the rate of drug overdose deaths involving fentanyl increased exponentially for both sexes, men are dying of overdose at nearly three times the rate of women in the United States. Rates also increased exponentially across all age groups, with a steep rise in the number of fentanyl overdose deaths among young adults ages 25 to 34. Exponential increases were also seen for rates among race and ethnicity groups, with death rates increasing faster among black and Latino Americans than among whites.
Centers for Disease Control and Prevention: Drug Overdose Deaths Involving Fentanyl, 2011–2016. National Vital Statistics Reports. Mar 21, 2019. Spencer M, et. al. 2019;68(3).
Drug and Opioid Overdose Deaths – United States – 2013-2017
In 2017 approximately 67.8% of drug overdose deaths involved opioids and 59.8% of those involved synthetic opioids like fentanyl. Furthermore, from 2010-2016, there were significant increases in overdose deaths involving synthetic opioids that also involved other illicit or prescription drugs. There is increasing research on using drugs in combination with each other, referred to as polysubstance use, which has found that the trend of using multiple substances is a growing trend. The increase in polysubstance drug use means that opioid overdoses often includes the use of more than one drug at once.
Centers for Disease Control and Prevention: Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017, Morbidity and Mortality Weekly Report (MMWR). Scholl L, Seth P, et. al. January 4, 2019. 67(5152);1419–1427.
Centers for Disease Control and Prevention. Other Drugs. Accessed Mar 25, 2019.
Journal of the American Medical Association (JAMA) Network. Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. Jones CM, Einstein EB, et al. 2018;319(17):1819-1821.
Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016
From 2011 through 2016, the age-adjusted rate of drug overdose deaths involving heroin more than tripled, as did the rate of drug overdose deaths involving methamphetamine. The rate of drug overdose deaths involving fentanyl and fentanyl analogs doubled each year from 2013 through 2016.
Centers for Disease Control and Prevention. Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016. National Vital Statistics Reports. Dec 12, 2018. Hedegaard H, et. al. 2018;67(9).
FDA Takes Important Steps to Stem the Tide of Opioid Misuse and Abuse
The US Food and Drug Administration (FDA) has continued to take important steps to address the opioid addiction crisis. For example, the FDA has expanded the REMS to include immediate-release opioid analgesics. In addition, the FDA is also considering the development of additional evidence-based guidelines to assist physicians with appropriate prescribing. The FDA issued a final guidance document that will assist potential applicants who plan to develop and submit an application to seek approval of a generic version of abuse-deterrent formulations (ADFs) of opioid drugs.
US Food and Drug Administration. FDA Takes Important Steps to Stem the Tide of Opioid Misuse and Abuse. Sept 28, 2017. Gottlieb S. Accessed Mar 17, 2019.
US Food and Drug Administration. Addressing Needs of Patients While Stemming the Tide of the Opioid Crisis. May 14, 2018. Gottlieb S. Accessed Mar 17, 2019.
The President’s Commission on Combating Drug Addiction and the Opioid Crisis
In 2017, President Trump announced that his Administration was declaring the opioid addiction crisis a national Public Health Emergency under federal law. The White House Commission’s report outlines the Trump Administration’s initiatives and proposals to address the crisis. Top priorities for the Commission include more data sharing among state-based prescription drug monitoring programs, equipping all law enforcement officers across the country with life-saving naloxone and a full enforcement of the Mental Health Parity and Addiction Equity Act to ensure that health plans provide the same benefits for mental health and substance use diagnoses as for physical health ailments. The report includes recommendations that will help doctors, addiction treatment providers, parents, schools, patients, faith-based leaders, law enforcement, insurers, the medical industry, and researchers “fight opioid abuse and misuse by reducing federal barriers and increasing support to effective programs and innovation.”
The US White House. The President’s Commission On Combating Drug Addiction And The Opioid Crisis: Final Report. Nov 1, 2017. Accessed Mar 17, 2019.
The National Survey on Drug Use and Health: 2017
The National Survey on Drug Use and Health (NSDUH) is a comprehensive household interview survey of substance use, substance use disorders, mental health, and the receipt of treatment services for these disorders in the United States. The 2017 data show a significant decrease in prescription opioid abuse from 2015.
US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. The National Survey on Drug Use and Health: 2017. Sept 2018. McCance-Katz EF. Accessed March 17, 2019.
Mortality Risk During and After Opioid Substitution Treatment: Systematic Review and Meta-Analysis of Cohort Studies
Medication-assisted treatment such as methadone and buprenorphine can substantially reduce the risk of death by overdose or other causes in people dependent on opioids.
Sordo L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j155. Accessed Mar 17, 2019.