Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids. In fact, opioids were involved in over 28,000 deaths in 2014, and opioid overdoses have quadrupled since 2000. Turning the tide on this epidemic means that, along with our own work, CDC supports partners across the country in efforts to reduce opioid abuse – including through research, surveillance, and communication campaigns, as well as prevention program development, implementation and evaluation.
In August 2016, CDC’s Injury Center announced awards to a number of states and institutions to fund work aimed at curbing prescription and illicit opioid misuse, abuse, and overdose.
Research on Prescription Opioid Use, Opioid Prescribing, and Associated Heroin Risk
CDC is funding research focused on relevant opioid related priorities to identify:
- Patterns of prescription opioid pain reliever (OPR) use and misuse, and initiation of heroin use during and/or after OPR misuse, and
- The extent to which and under what circumstances OPR prescribing practices and policies aimed at curbing inappropriate prescribing are related to heroin initiation and heroin overdoses.
CDC awarded the University of California San Diego funds to support the OPR Misuse/Use and Transitions to Heroin and Injecting in Suburban and Exurban Southern California project. UCSD will recruit suburban and exurban drug users who are misusing prescription opioids or who have recently transitioned to injecting opioids and/or heroin use to investigate initiation of prescription opioids, factors associated with transition to injecting and/or heroin use, and barriers to accessing medication assisted treatment, HIV and HCV testing, overdose prevention, and clean needles.
CDC awarded Oregon State University funds to investigate the relationship among prescription opioid use, policies for improving opioid prescribing, and heroin-related outcomes. The state of Oregon recently developed a Performance Improvement Project (PIP) to reduce the proportion of high-dose opioid prescriptions in its Medicaid program delivered through 16 regional Coordinated Care Organizations (CCOs). Because each CCO has flexibility to address the state's PIP, implementation across CCOs constitutes a natural experiment to study policy factors associated with change in OPR prescribing and heroin-related outcomes.
CDC awarded Public Health Foundation Enterprises funds to conduct Heroin and Other Illicit Opioid Use and Overdose among Pain Patients (HOPP), a longitudinal retrospective study of patients who have received opioid pain relievers for chronic non-cancer pain. The investigators will study the association between opioid pain reliever dose changes and heroin initiation and overdose, and conduct analyses to better understand the impact of changes in opioid prescribing policy, such as dose limits, urine testing, and prescription drug monitoring program checks, on patient outcomes.
Findings from these studies will contribute to an understanding of individual risk factors for transition to and overdose with heroin, and assist local and national decision makers about policy levers to reduce the burden of OPR and heroin-related morbidity and mortality.
The Prescription Drug Overdose: Data-Driven Prevention Initiative (DDPI)
Washington D.C. and 13 states—Alabama, Alaska, Arkansas, Georgia, Hawaii, Idaho, Kansas, Louisiana, Michigan, Minnesota, Montana, New Jersey, and South Dakota—were selected to receive funds through the Prescription Drug Overdose: Data-Driven Prevention Initiative (DDPI). Funding will be used to advance and evaluate state-level actions to address opioid misuse, abuse, and overdose. That includes helping states build their ability to:
- Improve data collection and analysis around opioid misuse, abuse, and overdose;
- Develop a strategy, based on analysis of the data, that addresses the behaviors driving prescription opioid dependence and abuse; and
- Work with communities to develop more comprehensive opioid overdose prevention programs.
Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality
CDC is funding 12 states to better track opioid-involved nonfatal and fatal overdoses over a three-year project period. Timely data is needed to monitor rapid changes in the types of opioids contributing to overdose deaths. Improved surveillance will assist key stakeholders in improving prevention and response efforts by providing more timely data on fatal and nonfatal opioid overdose and in-depth information on risk factors that can be targeted for intervention.
The 12 states receiving program funds are: Kentucky, Maine, Massachusetts, Missouri, New Hampshire, New Mexico, Ohio, Oklahoma, Pennsylvania, Rhode Island, West Virginia, and Wisconsin. States will use the funding to:
- Increase the timeliness of reporting nonfatal and fatal opioid overdose and associated risk factors;
- Disseminate surveillance findings to key stakeholders working to prevent opioid-involved overdoses; and
- Share data with CDC to support improved multi-state surveillance of and response to opioid-involved overdoses.
Prevention for States Supplemental Funding
The Prescription Drug Overdose: Prevention for States program, which currently funds 29 states, is now providing additional dollars in one-year supplemental funding to 14 states to support their ongoing work to end the opioid overdose crisis. States will use this funding to enhance PDMPs, further prevention efforts; work with health systems, insurers, and professional providers to help them make informed decisions; and investigate the connection between prescription opioid abuse and heroin use.
The 14 states receiving supplemental funding are: California, Colorado, Indiana, Kentucky, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Washington, and Wisconsin. The supplemental funding awardees will address issues such as high overdose death rates in tribal communities and improving toxicology and drug screening.