Mandatory provider review and pain clinic laws reduce the amounts of opioids prescribed and overdose death rates
State policies, specifically mandated provider review of state-run prescription drug monitoring program (PDMP) data and pain clinic laws, reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent, during 2006–2013. Additionally, there is no evidence to support the claim that policies to curb opioid prescribing are leading to heroin overdoses. These policies may actually reduce the number of people initiating heroin use in the longer term by reducing the number of people exposed to opioids both for use as prescribed and for nonmedical use.
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CDC Vital Signs
- Today’s Heroin Epidemic – More People at Risk, Multiple Drugs Abused
- Opioid Painkiller Prescribing - Where You Live Makes a Difference
- Prescription Painkiller Overdoses - A Growing Epidemic, Especially Among Women
- Use and Abuse of Methadone as a Painkiller
- Prescription Painkiller Overdoses in the US
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- Deborah Fulton-Kehoe, Mark D. Sullivan, Judith A. Turner, Renu K. Garg, Amy M. Bauer, Thomas M. Wickizer, Gary M. Franklin. Opioid Poisonings in Washington State Medicaid. Medical Care, 2015; 53 (8): 679 DOI: 10.1097/MLR.0000000000000384. (CDC funded study)
- Jones C, Campopiano M, Baldwin G, McCance-Katz E. (2015). National and State Treatment Need and Capacity for Opioid Agonist Medication-Assisted Treatment. American Journal of Public Health. DOI:10.2105/AJPH.2015.302664.
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- Mack KA, Zhang K, Paulozzi L, Jones C. Prescription Practices involving Opioid Analgesics among Americans with Medicaid, 2010. J Health Care Poor Underserved. 2015;26(1):182-98.
- Haegerich, T.M., Paulozzi, L., Manns, B., & Jones, C. J. (2014). What we know and don’t know about state and system level policy strategies to prevent prescription drug overdose. Drug and Alcohol Dependence. DOI: 10.1016/j.drugalcdep.2014.10.001.
- Jones C, Paulozzi L, Mack K. Sources of prescription opioid pain relievers by frequency of past-year nonmedical use: United States, 2008–2011. JAMA Int Med 2014; 174(5):802-803.
- Baumblatt JA, Wiedeman C, Dunn J, Schaffner W, Paulozzi L, Jones T. High-risk use by patients prescribed opioids for pain and its role in overdose deaths. JAMA Int Med 2014;174(15):796-801.
- Paulozzi L, Zhang K, Jones C, Mack K. Risk of adverse health outcomes with increasing duration and regularity of opioid therapy. J Am Board Fam Med 2014;27:329-338.
- Sauber-Schatz, EK. Mack KA, Diekman ST, Paulozzi LJ. Associations between pain clinic density and distributions of opioid pain relievers, drug-related deaths, hospitalizations, emergency department visits and neonatal abstinence syndrome in Florida. Drug Alc Depend 2013; http://dx.doi.org/10.1016/j.drugalcdep.2013.05.017.
- Logan J, Liu Y, Paulozzi LJ, Zhang K, Jones C. Opioid prescribing in emergency departments: the prevalence of potentially inappropriate prescribing and misuse. Med Care 2013; doi:10.1097.
- Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002-2004 and 2008-2010. Drug Alc Depend 2013. Available at: http://dx.doi.org/10.1016/j.drugalcdep.2013.01.007.
- Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA 2013;309:657-659.
- Paulozzi LJ. Prescription drug overdoses: a review. Journal of Safety Research, 2012; 43(4): 283-289.
- Jones, C. Frequency of prescription pain reliever nonmedical use: 2002-2003 and 2009-2010. Arch Intern Med, 2012;172(16):1265-1267.
- Kenan K, Mack K, Paulozzi LJ. Trends in prescriptions for oxycodone and other commonly used opioids in the United States, 2000-2010. Open Med 2012:6(2)e41.
- Paulozzi LJ, Kilbourne EM, Shah NG, Nolte KB, Desai HA,Landen MG, Harvey W, Loring LD. A history of being prescribed controlled substances and risk of drug overdose death. Pain Medicine 2012;13:87-95.
- Paulozzi LJ, Weisler RH, Patkar AA. A National Epidemic of Unintentional Prescription Opioid Overdose Deaths: How Physicians Can Help Control It. J Clin Psychiatry. 2011; 72(5):589-592.
- Paulozzi L, Kilbourne E, Desai H. Prescription drug monitoring programs and death rates from drug overdose. Pain Med 2011;12:747-754.
- Toblin R, Mack K, Perveen G, Paulozzi L. A population-based survey of chronic pain and its treatment with prescription drugs. Pain 2011;152(6):1249-55.
- Paulozzi LJ, Stier, DD. Prescription drug laws, drug overdoses, and drug sales in New York and Pennsylvania. J Pub Health Policy 2010;31:422-432.
- Toblin RL, Paulozzi LJ, Logan JE, Hall AJ, Kaplan JA. Mental illness and psychotropic drug use among prescription drug overdose deaths: a medical examiner chart review. J Clin Psych 2010;71:491-496.
- Paulozzi LJ, Logan JE, Hall AJ, McKinstry E, Kaplan JA. A comparison of drug overdose deaths involving methadone and other opioid analgesics in West Virginia. Addiction 2009; 104:1541-1548.
- Hall AJ, Logan JE, Toblin RL, Kaplan JA, Kraner JC, Bixler D, Crosby AE, Paulozzi LJ. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 2008;300:2613-2620.
- Paulozzi LJ, Xi L. Recent changes in drug poisoning mortality in the United States by urban-rural status and by drug type. Pharmacoepidemiol Drug Safety 2008;17:997-1005.
- Paulozzi LJ, Annest J. US data show sharply rising drug-induced death rates. Injury Prevention 2007;13:130-132.
- Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology and Drug Safety 2006; 15:618-627.
- Paulozzi LJ and Ryan GW. Opioid analgesics and rates of fatal drug poisoning in the United States. Am J Prev Med. 2006;31:506–11.
- Paulozzi LJ. Opioid analgesic involvement in drug abuse deaths in the American metropolitan areas. American Journal of Public Health 2006; 96:1755-1757.
- Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology and Drug Safety 2006; 15:618-627.
- Barbour KE, Boring M, Helmick CG, Murphy LB, Qin J. Prevalence of Severe Joint Pain Among Adults with Doctor-Diagnosed Arthritis — United States, 2002–2014. MMWR Morb Mortal Wkly Rep 2016;65:1052–1056. DOI: http://dx.doi.org/10.15585/mmwr.mm6539a2
- García MC, Dodek AB, Kowalski T, et al. Declines in Opioid Prescribing After a Private Insurer Policy Change — Massachusetts, 2011–2015. MMWR Morb Mortal Wkly Rep 2016;65:1125–1131. DOI: http://dx.doi.org/10.15585/mmwr.mm6541a1
- Gladden RM, Martinez P, Seth P. Fentanyl Law Enforcement Submissions and Increases in Synthetic Opioid–Involved Overdose Deaths — 27 States, 2013–2014. MMWR 2016; 65(33);837–843.
- Peterson AB and Gladden RM, Delcher C, Spies E, Garcia-Williams A, Wang Y, Halpin J, Zibbell J, McCarty CL, DeFiore-Hyrmer J, DiOrio, M, and Goldberger B. Increases in fentanyl-related overdose deaths – Florida and Ohio, 2010-2015. MMWR 2016; 65(33);844–849.
- Jones CM, Baldwin GT, Manocchio T, White JO, Mack KA. Trends in Methadone Distribution for Pain Treatment, Methadone Diversion, and Overdose Deaths — United States, 2002–2014. MMWR Morb Mortal Wkly Rep 2016; 65:667–671. DOI: http://dx.doi.org/10.15585/mmwr.mm6526a2
- Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016; 65:1–49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1
- Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. MMWR 2015; 64(50);1378-82.
- Related page: State Data
- Paulozzi LJ, Strickler GK, Kreiner PW, Koris CM. Controlled Substance Prescribing Patterns — Prescription Behavior Surveillance System, Eight States, 2013. MMWR 2015; 64(SS09):1-14.
- Jones CM, Logan J, Gladden RM, Bohm MK. Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013. MMWR 2015; 64(26):719-725.
- Paone D, Tuazon E, Kattan J, Nolan ML, O'Brien DB, Dowell D, Farley TA, Kunins HV. Decrease in Rate of Opioid Analgesic Overdose Deaths — Staten Island, New York City, 2011–2013. MMWR 2015; 64(18):491-494.
- Rudd RA, Paulozzi LJ, et al. Increases in Heroin Overdose Deaths — 28 States, 2010 to 2012. MMWR 2014; 63: 849-854.
- Johnson H, Paulozzi LJ, Porucznik C, Mack K, Herter B. Decline in drug overdose deaths after state policy changes – Florida, 2010-2012. MMWR 2014; 63(26):569-574.
- Jones CM, Paulozzi LJ, Mack KA. Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse–Related Emergency Department Visits and Drug-Related Deaths — United States, 2010. MMWR 2014; 63: 881-885.
- Paulozzi LJ, Mack KA, Hockenberry JM. Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012. MMWR 2014; 63(26);563-568.
- Johnson H, Paulozzi LJ, Porucznik C, Mack K, Herter B. Decline in Drug Overdose Deaths After State Policy Changes — Florida, 2010–2012. MMWR 2014; 63(26);569-574.
- Mack KA, Jones CM, Paulozzi LJ. Vital Signs: Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women — United States, 1999–2010. MMWR 2013; 62(26);537-542.
- Paulozzi LJ, Mack KA, Jones CM. Vital Signs: Risk for Overdose from Methadone Used for Pain Relief — United States, 1999–2010. MMWR 2012; 61(26): 493-497.
- Paulozzi LJ, Baldwin G, et al. CDC Grand Rounds: Prescription Drug Overdoses — a U.S. Epidemic. MMWR 2012; 61(01):10-13.
- Paulozzi LJ, Jones CM, Mack KA, Rudd RA. Vital Signs: Overdoses of Prescription Opioid Pain Relievers---United States, 1999—2008. MMWR 2011; 60(43):1487-1492.
- Goldberger B, Thogmartin J, Johnson H, Paulozzi LJ, Rudd RA, Ibrahimova, A. Drug Overdose Deaths --- Florida, 2003--2009. MMWR 2011; 60(26);869-872.
- Paulozzi LJ. Drug-induced deaths—United States 2003–2007. MMWR 2011; 60(supp):60-61.
- Cai R, Crane E, Poneleit K, Paulozzi LJ. Emergency department visits involving nonmedical use of selected prescription drugs – United States, 2004–2008. MMWR 2010; 59:705-709.
- Mascola L, Dassey D, Fogleman S, Paulozzi LJ, Reed CG. Ecstasy overdoses as a New Year’s Eve rave—Los Angeles, California, 2010. MMWR 2010; 59:671-681.
- Coolen P, Best S, Lima A, Sabel J, Paulozzi LJ. Overdose deaths involving prescription opioids among Medicaid enrollees—Washington, 2004-2007. MMWR 2009; 58:1171-1175.
- Centers for Disease Control and Prevention. QuickStats: Percentage change in death rates for the leading causes of unintentional injury, by mechanism of injury --- United States, 1999—2005. MMWR 2008; 57:701.
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- Centers for Disease Control and Prevention. CDC Health Advisory: Influx of Fentanyl-laced Counterfeit Pills and Toxic Fentanyl-related Compounds Further Increases Risk of Fentanyl-related Overdose and Fatalities. HAN Health Advisory. August 25, 2016.
- Centers for Disease Control and Prevention. CDC Health Advisory: Increases in Fentanyl Drug Confiscations and Fentanyl-related Overdose Fatalities. HAN Health Advisory. October 26, 2015.
- Hedegaard H, Chen LH, Warner M. Drug-poisoning Deaths Involving Heroin: United States, 2000–2013. NCHS data brief, no. 190. Hyattsville, MD: National Center for Health Statistics, 2015.
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- Chen LH, Hedegaard H, Warner M. Drug-poisoning deaths involving opioid analgesics: United States, 1999–2011. NCHS data brief, no 166. Hyattsville, MD: National Center for Health Statistics. 2014.
Addressing Prescription Drug Abuse in the United States: Current Activities and Future Opportunities [PDF - 1 MB]
Created by the Department of Health and Human Services’ Behavioral Health Coordinating Committee Subcommittee on Prescription Drug Abuse, this publication is a review of current federal initiatives and literature focused on ensuring the safe use of prescription drugs with the potential for abuse and the treatment of prescription drug dependence. The report includes identified opportunities to enhance programmatic and policy efforts as well as future research on prescription drug abuse and overdose in the U.S. (This publication was developed pursuant to Section 1122 of the Food and Drug Administration Safety and Innovation Act of 2012 (FDASIA).)
Policy Impact: Prescription Painkiller Overdoses [PDF - 1 MB]
Prescription Painkiller Overdoses is one in a series of issue briefs highlighting key public health issues and important, science-based policy actions that can be taken to address them. Through this publication, CDC supports state-based efforts to reduce prescription drug abuse while ensuring patients have access to safe, effective pain treatment. The publication includes information about deaths and emergency department visits resulting from prescription painkiller overdoses, overdose trends, the most common drugs involved, and the regions and populations most severely affected. Recommendations on how health care providers, private insurance providers, and state and federal agencies can work to prevent unintentional drug overdoses are also included.
Prescription Drug Overdose: State Health Agencies Respond [PDF - 1 MB]
To assess the knowledge, response, and planning regarding prescription drug misuse and overdose, in late 2007 the Association of State and Territorial Health Officials (ASTHO) and CDC conducted interviews with state and territorial health officials and other senior leaders in nine states (Arkansas, Florida, Indiana, Kentucky, Montana, North Carolina, Oklahoma, Utah, and West Virginia). The resulting report, Prescription Drug Overdose: State Health Agencies Respond, outlines the state perceptions, partnerships, recommendations, policies, and other issues that are fundamental to understanding and responding to drug misuse.
- NCHS. NCHS data on drug poisoning deaths. 2012. Available at: http://www.cdc.gov/nchs/data/factsheets/factsheet_drug_poisoning.html.
- Warner M, Chen LH, Makuc DM, Anderson RN, Miniño AM. Drug poisoning deaths in the United States, 1980-2008. NCHS data brief, no. 81. Hyattsville, MD: National Center for Health Statistics, 2011.
- Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999–2006. NCHS data brief, no. 22. Hyattsville, MD: National Center for Health Statistics, 2009.
- Fingerhut LA. Increases in Poisoning and Methadone-Related Deaths: United States, 1999-2005. NCHS Health E-Stat. Hyattsville, MD: National Center for Health Statistics. 2008.
Guides and Meeting Reports
Prescription Drug Overdose Data & Statistics Guide to ICD-9-CM and ICD-10 Codes Related to Poisoning and Pain [PDF - 64 KB]
This guide provides a list of the International Classification of Disease (ICD) version 10 (ICD-10) and the ICD version 9 Clinical Modification (ICD-9-CM) codes for poisoning and pain. This list can be used to query databases featuring either morbidity (ICD-9-CM) or mortality (ICD-10) data.
Prescription Drug Overdose Data & Statistics Guide: CDC WONDER Multiple Causes of Death Dataset [PDF - 603 KB] This guide provides an overview of the steps to query Multiple Causes of Death data in CDC WONDER. CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) is a data system that provides public-use data sets about mortality (deaths), cancer incidence, HIV and AIDS, tuberculosis, vaccinations, natality (births), census data and many other health outcomes. Multiple Causes of Death (MCOD) mortality data are based on death certificates for U.S. residents. Each death certificate contains underlying cause and up to twenty multiple causes of death and demographic data.
From Epi to Policy: Prescription Drug Overdose: State Health Department Training and Technical Assistance Meeting [PDF - 4 MB]
This report was prepared to summarize a meeting of health officials from 15 states funded to receive training on how to take what we know about the epidemic of Prescription Drug Overdose and turn it into effective action. The meeting sought to combine CDC’s research and epidemiology on prescription drug overdose with real-world discussions of the challenges and successes states have faced in confronting the epidemic. (Atlanta, Georgia, April 22-23, 2013)
Patient Review and Restriction Programs: Lessons learned from state Medicaid programs [PDF - 4 MB]
This report is a summary of an expert meeting to examine current practices of Patient Review and Restriction (PRR) programs and share insights about the operation of such programs to prevent prescription drug abuse, diversion, and overdose. (CDC Expert Panel Meeting Report, Atlanta, Georgia, August 27-28, 2012)
PBSS Data Briefs
Prescription Behavior Surveillance System Data Briefs
An analysis of Washington prescription drug monitoring program (PDMP) data revealed that multiple provider episodes (MPEs) vary by age group and class of prescription drug. Opioids and opioid combinations had the highest number of days of overlapping prescriptions, and eight opioids had a mean daily dosage greater than 120 morphine milligram equivalents (MME). Findings indicate that MPEs, overlapping prescription, and mean daily dosages over 100 MMEs are patient risk factors to look for in PDMP data.
Maine’s PDMP data was analyzed to examine several patient risk measures for prescription drug misuse, abuse and overdose. Patients aged 35-54 had the highest rate of MPEs, and opioids were the drug class most frequently involved with MPEs. However, the rate of MPEs declined from 2010 to 2014, and this coincided with an increase in prescribing of buprenorphine, widely used in treating opioid dependence.