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 worse. Other states have twice Georgia’s rate of opiate overdose.
One of the hardest challenges I faced as Director of the Centers for Disease Control and Prevention (CDC) was the opiate epidemic. 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 – this includes 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 one 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 pass legislation that could save lives, particularly by giving doctors the tools to improve prescribing patterns. Part of this legislation increases access to naloxone to reverse overdoses. This is important. What’s even more critical is to prevent people from getting addicted to these medications in the first place.
Georgia can greatly improve the effectiveness of its Prescription Drug Monitoring Program (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 also help doctors avoid writing overlapping prescriptions or prescribing drugs with potentially harmful interactions – as when a patient takes both opiates and benzodiazepines. Stated simply, PDMPs are among the most important state-level interventions to address the opiate epidemic.
In Georgia today, the PDMP isn’t used consistently. In states with laws regulating pain clinics and requiring PDMP checks, deaths from opioids have decreased. The legislation under consideration would improve the timeliness of prescription information into Georgia’s PDMP.
In addition to requiring doctors to check the PDMP (and allowing delegates to do so to make this more feasible), other key features are important if the legislation is to protect Georgians:
- All Opioids and Benzodiazepines: Doctors should be required to provide data and check the database for all opiates and all benzodiazepine medications before making the decision to start treatment with an opiate. One draft bill provides that only 3 of many benzodiazepines be included; there is no rational reason for this – all benzodiazepines act in the same basic way, and all increase the lethality of opiates.
- Few Exemptions to Checking the PDMP: Only rare exemptions from checking the PDMP – such as the five outlined in the Senate version of the bill, including opiates prescribed for palliative or end of life care, addiction treatment – should be allowed.
- Active Management: Georgia's PDMP needs to be actively managed so prompt action is taken to protect patients. To do this, Georgia's PDMP needs the legislature to provide adequate funds.
Already, too many lives have been lost in Georgia to this epidemic. Effective action by the Legislature in the coming days can save lives. Families throughout Georgia are counting on our elected officials to do the right thing and pass legislation that makes 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.
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