The United States – and Georgia – is in the midst of a horrific epidemic of opiate overdose. Every day, a Georgian dies of an opiate overdose. Most of those who die are young adults. Their deaths are tragic for their families and communities, and all of us are poorer because they can no longer contribute to our society. And it could get much worse. Other states have twice Georgia’s rate of opiate overdose.
The opiate epidemic was one of the hardest challenges I faced as Director of the Centers for Disease Control and Prevention (CDC). Since 2000, more than 300,000 of our sons, daughters, brothers, sisters, mothers, fathers, and friends have been killed by opiates. In 1999, approximately 6,000 Americans died from an opiate overdose – including both prescription pain medicines (such as OxyContin, Vicodin, and Percocet) and heroin. By 2015, that number increased to more than 33,000 – more than five times the number of deaths in 1999.
Overprescribing of opiates – which are no less addictive than heroin – has driven this devastation. Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, but there has been no change in the amount of pain Americans report. Prescription opiates are a gateway drug – the great majority of those addicted to heroin got started with opioid medications. This is one reason CDC released opioid prescribing guidelines for chronic pain a year ago.
Reversing this epidemic won’t be simple, and won’t be quick – but the sooner we take effective action, the more lives will be saved. To their credit, Georgia’s political leaders are working to do so by improving Georgia’s Prescription Drug Monitoring Programs (PDMP). PDMPs collect information on controlled substance prescriptions so doctors can review the data before making the decision to prescribe an opiate or benzodiazepine. PDMPs help doctors avoid writing overlapping prescriptions or prescribing drugs with potentially harmful interactions – as when a patient takes both opiates and benzodiazepines. PDMPs are among the most important state-level interventions to address the opiate epidemic. In states with laws regulating pain clinics and requiring PDMP checks, deaths from opioids have decreased.
In Georgia today, the PDMP isn’t used consistently. This past Thursday, the Senate Health Committee approved House Bill 249 that would require doctors to check our state PDMP before prescribing all opioids and all benzodiazepines. It also sensibly allows for delegates to do so, saving our doctors time.
Unfortunately, this version of the bill has too many loopholes. The Senate version of the bill had sensible exemptions, including opiates prescribed for palliation, end-of-life care, and addiction treatment. The current draft includes exemptions that would endanger public safety and result in avoidable overdoses and deaths of Georgians.
First, it’s understandable that when doctors prescribe 3 days of medication they not have to check the PDMP - but only if this a one-time, non-renewable prescription.
Second, there is no reason to exempt outpatient surgery from PDMP checking: many people become addicted after receiving opiates for surgery. Just last week, new research found that surgeons had been prescribing six times as many pills as patients took following outpatient surgery. After 5 different types of outpatient surgery, patients took an average of only two to 11 pills — well within the first exemption in the PDMP legislation for 3 days of medication.
Third, the exemption from checking for patients in intermediate care homes, nursing homes, and personal care homes means that patients in these facilities would be at greater and avoidable risk for duplicate or dangerous prescriptions.
Fourth, patients being treated for cancer should benefit from the PDMP, as they do in other states with PDMPs. Nearly 1.7 million Americans, including nearly 17,000 Georgians, are diagnosed with cancer each year. An exemption already exists for palliative, hospice, and end-of-life care. Thankfully, cancer patients are surviving longer. There are 15 million cancer survivors in the US, and they deserve the same level of protection from addiction and overdose every other American, and Georgian, deserves.
Let’s be clear: checking the PDMP isn’t about reducing access to needed pain medicine, it’s about making prescriptions safer. Patients can still receive the medications their doctor deems necessary.
Of course, getting the right PDMP in place is only part of the solution. The legislature must provide funds to actively manage the system so prompt action is taken to protect patients. And both doctors and patients need to do more, together, to improve the management of both pain and addiction. For patients with chronic, non-cancer pain, opiates should be a last resort – for chronic pain, there’s no proof that they work and some evidence they can make pain worse.
Too many Georgians have already been killed in this epidemic. A final bill in the coming days that includes only the specific and well-worded exemptions included in Senate Bill 81 is safer for patients and will save lives. Families throughout Georgia are counting on our elected officials to do the right thing and make our PDMP work for doctors and protect patients.
Tom Frieden, M.D., MPH, was director of the U.S. Centers for Disease Control and Prevention from 2009 until January, 2017.