# data[].attributes.body
CDC Guideline for Prescribing Opioids for Chronic Pain. (2019, August 28). Retrieved July 23, 2020, from https://www.cdc.gov/drugoverdose/prescribing/guideline.html

Department of Health. (n.d.). Retrieved July 23, 2020, from https://www.health.ny.gov/professionals/narcotic/prescription_monitoring/

National Institute on Drug Abuse. (2020, May 01). New York: Opioid-Involved Deaths and Related Harms. Retrieved July 23, 2020, from https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/new-york-opioid-involved-deaths-related-harms

Opioid Overdose. (2020, May 05). Retrieved July 23, 2020, from https://www.cdc.gov/drugoverdose/index.html

# data[].attributes.body
Strategy #1
Continue to implement requirements for prescribers to utilize ISTOP with each controlled substance prescribed.
Strategy #2
Utilize the Center for Disease Control and Prevention's Guidelines for Prescribing Opioids for Chronic Pain.
How to reduce risks:
- By continued usage of the two strategies controlled substances will of lower availability to the public and decrease risk for adverse effects such as overdose.
How to improve outcomes/healthy lifestyle:
- Having prescribers more aware of the need for reduction in opioid prescribing and giving guidelines for evidence based practice leads to a reduction in overall prescriptions and lends to more nonpharmacological methods of pain relief.

# data[].attributes.attachment_link.readable_text
Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse or overdose from these drugs.

CDC developed and published the CDC Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than 3 months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care.

Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the risk of opioid use disorder, overdose, and death. More than 11.5 million Americans, aged 12 or older, reported misusing prescription opioids in 2016. ¹

An estimated 11% of adults experience daily pain

Millions of Americans are treated with prescription opioids for chronic pain

Primary care providers are concerned about patient addiction and report insufficient training in prescribing opioids

The CDC Guideline addresses patient-centered clinical practices including conducting thorough assessments, considering all possible treatments, closely monitoring risks, and safely discontinuing opioids. The three main focus areas in the Guideline include:

1. Determining when to initiate or continue opioids for chronic pain

Selection of non-pharmacologic therapy, nonopioid pharmacologic therapy, opioid therapy

Establishment of treatment goals

Discussion of risks and benefits of therapy with patients

2. Opioid selection, dosage, duration, follow-up, and discontinuation

Selection of immediate-release or extended-release and long-acting opioids

Dosage considerations

Duration of treatment

Considerations for follow-up and discontinuation of opioid therapy

3. Assessing risk and addressing harms of opioid use

Evaluation of risk factors for opioid-related harms and ways to mitigate patient risk

Review of prescription drug monitoring program (PDMP) data

Use of urine drug testing

Considerations for co-prescribing benzodiazepines

Arrangement of treatment for opioid use disorder

Calculating the total daily dose of opioids helps identify patients who may benefit from closer monitoring, reduction or tapering of opioids, prescribing of naloxone, or other measures to reduce risk of overdose.

To determine dose in MMEs, multiply the dose for each opioid by the conversion factor. For example, tablets containing hydrocodone 5 mg and acetaminophen 300 mg taken four times a day would contain a total of 20 mg of hydrocodone daily, equivalent to 20 MME daily; extended-release tablets containing oxycodone 10mg and taken twice a day would contain a total of 20mg of oxycodone daily, equivalent to 30 MME daily.

1. All doses should be in mg/day, except for fentanyl which should be in mcg/hr, before multiplying by the conversion factor.

2. Equianalgesic dose conversions are only estimates and cannot account for individual variability in genetics and pharmacokinetics.

3. Do not use the calculated dose in MMEs to determine the doses to use when converting opioid to another; when converting opioids the new opioid is typically dosed at substantially lower than the calculated MME dose to avoid accidental overdose due to incomplete cross-tolerance and individual variability in opioid pharmacokinetics.

4. Use particular caution with methadone dose conversions because the conversion factor increases at higher doses.

5. Use particular caution with fentanyl since it is dosed in mcg/hr instead of mg/day, and its absorption is affected by heat and other factors.

SOURCE: Adapted from Von Korff M, Saunders K, Thomas Ray G, et al. De facto long-term opioid therapy for noncancer pain. Clin J Pain. 2008 Jul-Aug; 24(6):521-527 and Washington State interagency guideline on prescribing opioids for pain; 2015.

For clinical guidance on dosage of opioids for treatment of chronic pain, please see these resources:

Additional clinical guidance, including opioid prescribing for acute pain, may be available through manufacturers' full prescribing informationexternal icon external icon or consultation with other clinicians with expertise and experience in pain management. Conversion factors for drugs prescribed or provided as part of medication-assisted treatment for opioid use disorder should not be used to benchmark against MME dosage thresholds meant for opioids prescribed for pain.

References

Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes - United States. Surveillance Special Report 2pdf icon . Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018.

Page last reviewed:

# data[].attributes.attachment_link.title
CDC Guideline for Prescribing Opioids for Chronic Pain

# data[].attributes.attachment_link.description
Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse or overdose from these drugs.

# data[].attributes.body
Opioid rated deaths in New York State have continued to rise with prescription medications being a major causative factor.

# data[].attributes.attachment_link.readable_text
Drug-Involved Overdose Deaths

In the U.S., there were 67,367 drug overdose deaths reported in 2018, 4.1% fewer deaths than in 2017.

The age-adjusted rate declined by 4.6% to 20.7 per 100,000 standard population.¹ The decline follows an increasing trend in the rate from 6.1 in 1999 to 21.7 in 2017.

Opioids were involved in 46,802 (a rate of 14.6) overdose deaths in 2018-nearly 70% of all overdose deaths.

Deaths involving synthetic opioids other than methadone (including fentanyl and fentanyl analogs) continued to rise with more than 28,400 (a rate of 9.9) overdose deaths in 2018.

The number of deaths involving prescription opioids declined to 14,975 (a rate of 4.6) in 2018 and those involving heroin dropped to 14,996 (a rate of 4.7).²

Figure 1. Number of drug and opioid-involved overdose deaths in New York, by opioid category. Drug categories presented are not mutually exclusive, and deaths may have involved more than one substance. Source: CDC WONDER, 2020.

In New York, drug overdose deaths involving opioids totaled 2,991 (a rate of 15.1) in 2018-a decline compared to the 2,166 (a rate of 10.8) in 2015.

Deaths involving synthetic opioids other than methadone (mainly fentanyl and fentanyl analogs) remained steady with 2,195 (a rate of 11.2) reported in 2018 (Figure 1).

Deaths involving heroin or prescription opioids also remained stable with a respective 1,243 (a rate of 6.3) and 998 (a rate of 4.9) deaths in 2018.³

Opioid Prescriptions

In 2018, New York providers wrote 34.0 opioid prescriptions for every 100 persons. One of the lowest rates in the country. The average U.S. rate in the same year was 51.4 prescriptions per 100 persons. ⁴

Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS)

NAS or NOWS may occur when a woman uses opioids during pregnancy. To date, there is no standard in NAS/NOWS provider and hospital coding practices. 5 As a result, there is variability in the rates reported by states.

The national incidence rate of NAS/NOWS in 2016 was 7 cases per 1,000 hospital births.6-7

The highest rates were reported among American Indian/Alaska Native (15.9 per 1,000 births) and White Non-Hispanic (10.5 per 1,000 births) individuals.

In 2016, hospital costs for NAS/NOWS births totaled $572.7 million, after adjusting for inflation.⁸

The incidence rate of NAS/NOWS in New York in 2017 was 14.7 cases per 1,000 hospital births and is the most recent data available.⁶⁻⁷

Figure 2. New York: Estimated percent of male vs. female with new HIV diagnoses, by transmission category, 2017. Percentages may not add up to 100% due to rounding. Source: CDC NCHHSTP, AtlasPlus.

New HIV Diagnoses⁹ and Prevalence Attributed to Injection Drug Use (IDU)

U.S. New Diagnoses: In 2017, 9.7% (3,690) of the 38,226 new HIV diagnoses were attributed to IDU. Among males, 8.6% (2,655) of new diagnoses were transmitted via IDU or male-to-male sexual contact and IDU. Among females, 14.2% (1,035) of new diagnoses were transmitted via IDU.¹⁰

U.S. Prevalence: In 2017, more than 1 million Americans were living with a diagnosed HIV infection-a rate of 367.7. Among males, 16.4% (125,274) contracted HIV from IDU or male-to-male sexual contact and IDU. Among females, 20.8% (49,288) were living with HIV attributed to IDU.¹⁰

State New Diagnoses: Of the new HIV diagnoses in 2017, 2,730 occurred in New York-a rate of 16.4. Among males, 8.0% of new HIV diagnoses were attributed to IDU or male-to-male sexual contact and IDU. Among females, 13.5% were attributed to IDU (Figure 2).¹⁰

State Prevalence: In 2017, 126,495 persons were living with a diagnosed HIV infection in New York-a rate of 760.2. Of those, 24.7% of male cases were attributed to IDU or male-to-male sexual contact and IDU. Among females, 28.5% were living with HIV attributed to IDU.¹⁰

Hepatitis C (HCV) Incidence and Prevalence Attributed to IDU¹¹

U.S. Incidence: In 2017, there were an estimated 44,700 new cases of acute HCV. Among case reports that contained information about IDU, 86.6% indicated IDU prior to onset of acute, symptomatic HCV.¹²

U.S. Prevalence: An estimated 2.4 million Americans are living with HCV (based on 2013-2016 annual average).¹²

State Incidence: There were approximately 188 new cases of acute HCV (a rate of 0.9) reported in New York in 2017.¹⁰

State Prevalence: In New York, there are an estimated 116,000 persons living with HCV (a rate of 750 based on 2013-2016 annual average).¹³

References

1. Rates are age-adjusted per 100,000 standard population unless otherwise noted.

2. Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999-2018. NCHS Data Brief, no 356. Hyattsville, MD: National Center for Health Statistics. 2020.

3. Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2018 on CDC WONDER Online Database released in 2020. Data are from the Multiple Cause of Death Files, 1999-2018, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. (2020 February 14) Retrieved from http://wonder.cdc.gov/mcd-icd10.html

4. Centers for Disease Control and Prevention. U.S. Opioid Prescribing Rate Maps. (2019, October 3). Retrieved from https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

5. Lind JN, Ailes EC, Alter CC, et al. Leveraging Existing Birth Defects Surveillance Infrastructure to Build Neonatal Abstinence Syndrome Surveillance Systems-Illinois, New Mexico, and Vermont, 2015-2016. MMWR Morb Mortal Wkly Rep 2019;68:177-180.

6. Healthcare Cost and Utilization Project (HCUP). Neonatal Abstinence Syndrome (NAS) Among Newborn Hospitalizations. (2019, December 12) Retrieved from https://www.hcup-us.ahrq.gov/faststats/nas/nasquery.jsp?

7. Comparisons with earlier estimates are difficult because of the ICD-10-CM transition in 2015.

8. Strahan AE, Guy Jr. GP, Bohm M, et al. Neonatal Abstinence Syndrome Incidence and Health Care Costs in the United States, 2016. JAMA Pediatrics. 2020;174(2):200-202.

9. The term refers to people diagnosed with HIV infection, regardless of the stage of disease at diagnosis.

10. Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) AtlasPlus. (2020, January 30). Retrieved from https://gis.cdc.gov/grasp/nchhstpatlas/main.html.

11. Not all states collect or report data on the incidence or prevalence of Hepatitis C or on how Hepatitis C is transmitted. When available, the data will be included.

12. Centers for Disease Control and Prevention. Surveillance for Viral Hepatitis-United States, 2017. 2019, November 14. Retrieved from https://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm

13. HepVu. Local Data: New York. Retrieved from https://hepvu.org/state/New York/

# data[].attributes.attachment_link.title
New York: Opioid-Involved Deaths and Related Harms | National Institute on Drug Abuse

# data[].attributes.attachment_link.description
In the U.S., there were 67,367 drug overdose deaths reported in 2018, 4.1% fewer deaths than in 2017. The age-adjusted rate declined by 4.6% to 20.7 per 100,000 standard population.1 The decline follows an increasing trend in the rate from 6.1 in 1999 to 21.7 in 2017.

# data[].attributes.body
Prescription of opioids increased dramatically since 1999 leading to devastating addition and mortality amongst Americans.

# data[].attributes.attachment_link.authors[].name
Centers for Disease Control and Prevention (CDC)

# data[].attributes.body
Prescription Drug Monitoring Programs such as the NYS Internet System for Tracking Over-Prescribing (ISTOP) was initiated in June 2013 in an attempt to lower the over-prescribing of controlled substances therefor lowering abuse and overdoses.

# data[].attributes.attachment_link.title
I-STOP/Prescription Monitoring Program (PMP) Internet System for Tracking Over-Prescribing /Prescription Monitoring Program

# data[].attributes.attachment_link.description
Information about the Prescription Monitoring Program and I-Stop