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The opioid epidemic continues to wreak havoc on the U.S.

The CDC recently issued prescribing guidelines; meanwhile, illicit combination drugs are a growing challenge in U.S.

SHARE The opioid epidemic continues to wreak havoc on the U.S.

Alex Cochran, Deseret News

The number of U.S. deaths attributed to drug overdoses appeared to be down very slightly month to month in early 2022, but the year-over-year trend was up, as it generally has been for years. Deaths from opioids have followed the same pattern.

Nearly 78,000 people in the U.S. died due to an opioid overdose in the 12-month period ending in May of 2022. Overall, more than 103,000 U.S. deaths have been attributed to drug overdose in that period, including those opioid deaths. And because of reporting lags, the numbers are likely an undercount, based on actual but incomplete data.

That’s according to an update of provisional drug overdose deaths data released Wednesday by the Centers for Disease Control and Prevention. The data is based on information available by Oct. 2, 2022, and doesn’t include drug deaths where the reporting was delayed or an investigation is ongoing.

Final numbers typically lag by several months, as the CDC releases its preliminary estimates for the most recent 12-month periods that are available, rather than by calendar years. That annual reckoning comes months later.

The issue of drug overdose deaths and the opioid epidemic is so severe that in 2016, the CDC issued recommendations for clinicians on how to prescribe opioid medications. Earlier this month, the CDC issued new prescribing guidelines in part to address some issues created in 2016, including that patients who were being treated for severe pain and the clinicians caring for them said some were being denied appropriate pain management tools.

Lawsuits have been filed against drug manufacturers and retailers alike in relation to the opioid crisis. For example, just this week Walmart agreed to a $3.1 billion settlement framework. Attorneys general from a number of states sued, saying the retail giant contributed to the opioid epidemic by failing to regulate opioid prescriptions.

In a statement, Walmart wrote that it “believes the settlement framework is in the best interest of all parties and will provide significant aid to communities across the country in the fight against the opioid crisis, with aid reaching state and local governments faster than any other nationwide opioid settlement to date, subject to satisfying all settlement requirements.” 

The statement emphasized there was no admission of liability.

Many of the deaths, however, are not among pain patients — though many of them died, as well — but are among those who became addicted to opioids and obtained them illicitly. Law enforcement officials are dealing with a crisis created by illicit opioids, including the synthetic opioid fentanyl which is being added in unpredictable amounts to other drugs. Often users do not know what they are taking.

Deadly combinations

Opioids were already a crisis, but emerging drug combinations are a nationwide twist. The Wall Street Journal reported this week that a combination of methamphetamines and opioids — “typically fentanyl” — are raising the number of overdose deaths. Citing preliminary federal data, the article reported that 1 in 5 fatal overdoses involved an opioid and a psychostimulant, compared to about 2% of drug deaths a decade ago.

“Meth-related deaths, though smaller in number, are increasing at a faster rate than opioid and overall drug fatalities,” according to the Journal, which noted that last year’s record-breaking number of overdose deaths — 108,000 — was largely due to fentanyl.

Christina Zidow, chief operating officer at Odyssey House of Utah, which treats substance use disorders, has seen firsthand what’s happening. She told the Deseret News that at Odyssey house, nearly half of clients “are endorsing methamphetamine as their primary drug of choice and opiates are a close second.”

The program has taken a number of harm-reduction steps, aimed at avoiding overdose deaths so that people have a chance to get treatment for their substance use disorder.

“We have seen an increase in positive feedback to our Martindale primary care clinic about our harm-reduction kits and the benefits of having fentanyl test strips,” she told the Deseret News.

She said those engaged in harm-reduction services are reporting finding fentanyl “in many different drugs, including pills, marijuana, methamphetamine and opiates.”

The Centers for Disease Control and Prevention opioid information page says prescription opioids include oxycodone (OxyContin), hydrocodone (Vicodin), morphine and methadone. Fentanyl is a synthetic opioid pain reliever. Heroin is an illegal opioid that kills 36 people a day in the U.S. 

CDC also said that three-fourths of the nearly 92,000 drug overdose deaths in 2020 involved an opioid. And 82% of those involved synthetic opioids (excluding methadone).

Per The Wall Street Journal: “About 33,400 deaths last year involved psychostimulants such as meth, up more than 340% from roughly 7,500 five years earlier, the federal data show. In the same time span, deaths involving synthetic opioids like fentanyl rose about 270% to around 72,000, and overall drug fatalities rose about 71%.”

“As with the illicit fentanyl trade, meth is made entirely from chemicals and is largely produced and distributed by Mexican drug cartels that make a potent version in clandestine labs and smuggle it north, according to the Drug Enforcement Administration,” the Journal reported.

Prescribing guidelines

In a media briefing on the new opioid prescribing guidelines, CDC officials said the goal is to address pain care, not to tackle the illicit opioid impact that has contributed greatly to the number of opioid deaths.

Dr. Christopher Jones, acting director for the National Center for Injury Prevention and Control and the co-author of the 2022 clinical practice guidelines, said that the drug overdose death crisis is largely driven by illicit synthetic opioids like fentanyl and resurgent methamphetamine. The guidelines, though, are about patients living with pain.

Among other things, the guidelines advise against abruptly stopping prescription opioid use or drastically tapering a dosage in a short period of time.

“We have seen that play out certainly in the research and also from personal stories from patients whose clinicians stop prescribing to them, or abandon them from care, or rapidly forced them to get too-much-lower doses of opioids. There are very real harms,” Jones told reporters.

The CDC’s new guidelines for prescribing opioids include 12 recommendations designed to determine whether opioids are the best option, how long they should be used, which opioids should be prescribed and at what dose and includes suggestions for weighing the risk and minimizing potential harm. 

The guidelines also recommend that those who receive opioids for chronic pain have naloxone in case of an opioid overdose, which the drug can reverse.

The public health agency emphasizes that the recommendations do not apply to managing pain for those with sickle cell disease, cancer, palliative care or end-of-life treatment.