US CDC Proposes Revised Guidelines for Prescribing Opioids

The U.S. Centers for Disease Control and Prevention (CDC) Thursday issued a draft of revised guidelines for prescribing opioid painkillers, urging doctors to be flexible and individualize their use of the drugs to the needs of the patient.

The CDC’s current guidelines were issued in 2016, largely in response to the over-prescribing of opioids in the United States from 2007 to 2012. The agency reports in 2012, 259 million prescriptions were written for the highly addictive painkillers, enough for every person in the country to have their own bottle.

The result was one of the worst drug-abuse epidemics in the U.S., with addiction and deaths related to the drugs skyrocketing. The CDC reports that from 1999 to 2014, more than 165,000 people in the United States died from overdoses related to opioid pain medication.

But CDC officials said that while 2016 guidelines helped end the over-prescribing of the drugs, they also may have pushed doctors too far in the other direction.

Co-author of the new guidelines, acting director of the National Center for Injury Prevention and Control, Christopher Jones, said some doctors were too quick to cut off patients taking prescription painkillers and too strict in keeping the drugs from patients who might benefit.

The 229-page draft of the updated guidelines removes some of the suggested limits the original guidelines placed on administering opioids and proposes individualized patient care. It also offers more options for treating the kind of short-term, acute pain that follows surgeries or injuries.

The CDC published the draft of the new guidelines in the U.S. Federal Register, where the public can view and comment on them for the next 60 days. The CDC will consider comments before finalizing the updated guidance.

CDC guidelines are voluntary, though they are widely followed by U.S. healthcare providers.

Some information in this report came from The Associated Press.

Report Calls for New US Strategy for Opioids

The U.S. needs a nimble, multipronged strategy and Cabinet-level leadership to counter its festering overdose epidemic, a bipartisan congressional commission advises.

With vastly powerful synthetic drugs like fentanyl driving record overdose deaths, the scourge of opioids awaits after the COVID-19 pandemic finally recedes, a shift that public health experts expect in the months ahead.

“This is one of our most pressing national security, law enforcement and public health challenges, and we must do more as a nation and a government to protect our most precious resource — American lives,” the Commission on Combating Synthetic Opioid Trafficking said in a 70-page report released Tuesday to Congress, President Joe Biden and the American people.

VOA Special Report: The Damage Done – Living America’s Opioid Nightmare

The report envisions a dynamic strategy. It would rely on law enforcement and diplomacy to shut down sources of chemicals used to make synthetic opioids. It would offer treatment and support for people who become addicted, creating pathways that can lead back to productive lives. And it would invest in research to better understand addiction’s grip on the human brain and to develop treatments for opioid use disorder.

The global coronavirus pandemic has overshadowed the American opioid epidemic for the last two years, but recent news that overdose deaths surpassed 100,000 in one year caught the public’s attention. Politically, federal legislation to address the opioid crisis won support across the partisan divide during both the Obama and Trump administrations.

Rep. David Trone, D-Md., a co-chair of the panel that produced the report, said he believes that support is still there, and that the issue appeals to Biden’s pragmatic side. “The president has been crystal clear,” Trone said. “These are two major issues in America: addiction and mental health.”

The U.S. government’s record is also clear. It has been waging a losing “war on drugs” for decades.

The stakes are much higher now with the widespread availability of fentanyl, a synthetic painkiller 80 to 100 times more powerful than morphine. It can be baked into illicit pills made to look like prescription painkillers or anti-anxiety medicines. The chemical raw materials are produced mainly in China. Criminal networks in Mexico control the production and shipment to the U.S.

FILE – This photo provided by the U.S. Drug Enforcement Administration’s Phoenix Division shows one of four containers holding some of the 30,000 fentanyl pills the agency seized in Tempe, Ariz., in August 2017.

Federal anti-drug strategy traditionally emphasized law enforcement and long prison sentences. But that came to be seen as tainted by racial bias and counter-productive because drug use is treatable. The value of treatment has recently has gained recognition with anti-addiction medicines in wide use alongside older strategies like support groups.

The report endorsed both law enforcement and treatment, working in sync with one another.

“Through its work, the commission came to recognize the impossibility of reducing the availability of illegal synthetic opioids through efforts focused on supply alone,” the report said.

“Real progress can come only by pairing illicit synthetic opioid supply disruption with decreasing the domestic U.S. demand for these drugs,” it added.

The report recommends what it calls five “pillars” for government action:

• Elevating the White House Office of National Drug Control Policy to act as the nerve center for far-flung federal efforts, and restoring Cabinet rank to its director.
• Disrupting the supply of drugs through better coordinated law enforcement actions.
• Reducing the demand for illicit drugs through treatment and by efforts to mitigate the harm to people addicted. Treatment programs should follow science-based “best practices.”
• Using diplomacy to enlist help from other governments in cutting off the supply of chemicals that criminal networks use to manufacture fentanyl.
• Developing surveillance and data analysis tools to spot new trends in illicit drug use before they morph into major problems for society.

Trone said it’s going to take cooperation from both political parties. “We have to take this toxic atmosphere in Washington and move past it,” he said. “Because 100,000 people, that’s husbands, sisters, mothers, fathers. As a country, we are better than that.”

Pharmacy Giants to Pay $590 Million to US Native Americans Over Opioids

NEW YORK — 

A group of pharmaceutical companies and distributors agreed to pay $590 million to settle lawsuits connected to opioid addiction among Native American tribes, according to a U.S. court filing released Tuesday.

The agreement is the latest amid a deluge of litigation spawned by the U.S. opioid crisis, which has claimed more than 500,000 lives over the past 20 years and ensnared some of the largest firms in American medicine.

The companies involved in the latest agreement include Johnson & Johnson (J&J) and McKesson, according to a filing in an Ohio federal court by a committee of plaintiffs in the case.

Native Americans have “suffered some of the worst consequences of the opioid epidemic of any population in the United States,” including the highest per-capita rate of opioid overdoses compared with other racial groups, according to the filing from the tribal leadership committee.

“The burden of paying these increased costs has diverted scarce funds from other needs and has imposed severe financial burdens on the tribal plaintiffs.”

J&J, McKesson and the other two companies in the accord – AmerisourceBergen and Cardinal Health – previously agreed to a $26 billion global settlement on opioid cases.

J&J said Tuesday the $150 million it agreed to pay in the Native American case has been deducted from what it owes in the global settlement.

“This settlement is not an admission of any liability or wrongdoing and the company will continue to defend against any litigation that the final agreement does not resolve,” the company said.

It was unclear if the other companies would take their portion under the latest agreement from the global settlement.

‘Measure of justice’

Robins Kaplan, a law firm negotiating on the behalf of the plaintiffs, said the agreement still must be approved by the Native American tribes.

“This initial settlement for tribes in the national opioid litigation is a crucial first step in delivering some measure of justice to the tribes and reservation communities across the United States that have been ground zero for the opioid epidemic,” Tara Sutton, an attorney at the firm, said in a statement.

Douglas Yankton, chairman of the North Dakota-based Spirit Lake Nation, said the money from the settlement would “help fund crucial, on-reservation, culturally appropriate opioid treatment services.”

Steven Skikos, an attorney representing the tribes, told AFP they are pursuing claims against other drugmakers.

“This is hopefully the first two of many other settlements,” he said.

All tribes recognized by the U.S. government, 574 in all, will be able to participate in the agreement, even if they have not filed lawsuits.

The settlement is separate from a prior agreement that resulted in $75 million in payments to the Cherokee Nation from three distribution companies, including McKesson.

Many of the lawsuits regarding the opioid crisis have centered on Purdue Pharma, the manufacturer of OxyContin, a highly addictive prescription painkiller blamed for causing a spike in addiction.

A judge in December overturned the company’s bankruptcy plan because it provided some immunity for the owners of the company in exchange for a $4.5 billion payout to victims of the opioid crisis.

The litigation wave also has swamped pharmacies owned by Walmart, Walgreens and CVS, which a jury found in November bear responsibility for the opioid crisis in two counties in Ohio.