This month, the Centers for Disease Control and Prevention (CDC) released their 2022 Clinical practice guideline for prescribing opioids for pain. The report is an update of the previous 2016 Guidelines, but takes a step back in the national fight against the opioid crisis.
In response, Dr. Kenneth A. Scheppke, Florida Assistant Secretary of Health, wrote the response below. It was published in the Wall Street Journal on November 21, 2022.
The United States has been grappling with the opioid crisis for nearly two decades.
In 2020, more than 90,000 Americans died from drug overdoses, with 75% of those deaths involving opioids. More Americans aged 18 to 45 died from drug overdoses in 2020 than from traffic accidents and suicides combined.
Opioid use disorder is a life-threatening, chronic condition that people get from exposure to opioids, whether illicit or prescribed by a doctor. In recognition of this, in 2016 the Centers for Disease Control and Prevention highlighted the risks of overprescribing and the need to limit opioid prescriptions to three days for acute pain. He also recommended that doctors avoid increasing the dose beyond 90 milligrams of morphine per day.
Yet in early November, the CDC updated its clinical practice guideline for prescribing opioids for pain. The updated recommendations set aside the limitation of opioid therapy to three days and remove the dosage recommendation. The accompanying 2022 report even says, “Opioids can be essential medications for pain management; however, they carry considerable potential risk.
“Potential risk? In the 2016 report, opioids were described as posing “serious risks including overdose and opioid use disorder”. There’s nothing potential about that. Well While opioids may be necessary for serious conditions and end-of-life care, the general public should not be told that they are “essential” for pain management.
Many medical professionals who have entered the practice over the past few decades will identify with episodes of the Hulu series “Dopesick,” which tells the story of the dark years before the dangers of opioids were understood. Overprescription of opioids has led to addiction and dependence on illicit drugs. In one study, 80% of heroin users said they started using illicit drugs after being prescribed opioids. Therefore, the warning to prescribers should be that prescriptions are often the pathway to illicit drug addiction and have contributed to the fentanyl crisis. I suspect many doctors will wonder why the new report overturns sound advice and downplays the clear and proven danger of opioids.
In Florida, we have made great strides in understanding this disease and the need for non-opioid pain treatment options. Our state has taken aggressive action to address the deadly opioid crisis through evidence-based treatment, while ensuring that those who knowingly contribute to the spread of this disease are held accountable.
Yet there has been an explosion of deadly fentanyl in our state both as a replacement for older illicit opioids and as an additive in many other illicit drugs. Since 2015, fentanyl-related overdose deaths have increased by 790% in Florida.
In response to these alarming statistics, Governor Ron DeSantis earlier this year signed tougher penalties for criminals selling this poison in our communities and developed Florida’s Coordinated Opioid Recovery Network, or CORE, to help sufferers. substance use disorders.
The CORE Network recognizes substance use disorders as a chronic, lifelong condition. Overdose is a symptom of this disease. To disrupt the revolving door of overdose and recovery for people with substance use disorders, CORE Network connects overdose cases to long-term, sustainable recovery resources. If someone in a CORE county overdoses, Protocol 911 will begin stabilization while transporting the patient to a specialty hospital with expertise in addiction medicine. Once all emerging health threats are stabilized, the patient’s long-term health care needs are identified and addressed. Patients are then connected to organizations that support sustainable recovery, including access to drug treatments, primary care, dental care, workforce development and more.
The CORE Network does not require overdose to access sustainable care services and provides the resources needed to achieve personalized, evidence-based care to support lifelong recovery. Florida is working tirelessly to expand this treatment model as the standard of care for recovery.
The nation has taken action to address this man-made catastrophe of opioid addiction, with a significant portion of the blame being placed squarely on pharmaceutical companies. With approximately $50 billion in global settlements for opioid recovery funds, we are well on our way to securing the resources we need to end this deadly epidemic.
The opioid crisis was caused by greed. The health care system was led to believe that these drugs were safe. Pharmaceutical companies have fraudulently convinced governments of safety. Patients have been over-prescribed these substances with devastating consequences. We begin to learn from our mistakes, reduce the stigma, recognize this disorder as the brain disease that it is, and take steps towards a better future. Now is not the time for the CDC to relax its recommendations on opioids.
Dr. Kenneth A. Scheppke is a licensed physician who is also a dual-certified specialist in emergency medicine and the EMS subspecialty. Dr. Scheppke received his medical degree from the Renaissance School of Medicine at Stony Brook University. He completed his internship and residency at the Medical Center of Delaware where he was elected chief resident.
Dr. Scheppke has over 25 years of extensive experience in EMS, and his contributions to the field have earned him national recognition and awards. A major key accomplishment is his leadership in the development of the CORE Network, initially piloted in Palm Beach County where he serves as the Fire Department Medical Director.
About the CORE Network
If you suspect an overdose, call 911 immediately. The State of Florida has deployed Resources that can be posted in public spaces to ensure Floridians remain alert to signs of overdose, how to respond, and where help is available.
CORE has been successfully piloted in Palm Beach County for nearly two years and is expanding to other counties to help patients break free from the deadly cycle of overdoses. Floridians struggling with addiction can use CORE to stabilize and receive drug treatment from a network of specialized medical experts who will help guide them on a sustained path to healthy success.
CORE Network is a partnership between the Florida Department of Health and the Department of Children and Families. Florida is proud of its efforts in battling the opioid epidemic and continues to do so with access, evidence-based care, and comprehensive treatment for life. Information about CORE and various recovery resources.
About the Florida Department of Health
The department, nationally accredited by the Public Health Accreditation Board, strives to protect, promote, and improve the health of all Florida residents through integrated state, county, and from the community.
Follow us on Twitter at @HealthyFla and on Facebook. For more information about the Florida Department of Health, please visit www.FloridaHealth.gov.
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