Archive for Opioid

2023 Prescribing and Pharmacology of Controlled Drugs Conference

2023 Prescribing and Pharmacology of Controlled Drugs Conference

The Medical Association of Alabama hosted its annual meeting on November 18-19, 2023, at the Hyatt Regency Birmingham-The Wynfrey Hotel in Birmingham, Alabama. The focal point of this gathering was the renowned “Prescribing and Pharmacology of Controlled Drugs Conference,” marking the 15th year of its occurrence and the 45th presentation of the 12-hour Prescribing and Pharmacology course. This conference attracted a substantial attendance of around three hundred healthcare providers from across the southeastern United States, including Alabama, Florida, Georgia, Louisiana, Tennessee, and Texas.

The conference served as a vital platform for healthcare professionals to delve into crucial aspects of prescribing practices and the pharmacology of controlled substances. With its long-standing tradition, the event has consistently provided an opportunity for medical practitioners to stay abreast of the latest developments in the field and enhance their understanding of safe and effective prescribing methods.

At the conference, we paid tribute to three individuals who have devoted extensive efforts to combat the opioid crisis in Alabama, Dr. Buddy Smith, Dr. Jerry Harrison, and Dr. Steven Furr. Regrettably, Dr. Furr was unable to be with us due to his demanding role as the newly elected President of the American Academy of Family Physicians.

It is often said that noticing an issue is easy, but taking decisive action is the real challenge. Over the course of the last fifteen years, these gentlemen have dedicated forty-seven weekends away from their families to educate healthcare providers on the judicious prescribing of controlled medications. This commitment goes beyond the weekends, as they have also invested countless hours on the planning committee, ensuring not only the coverage of highly relevant topics but also the selection of expert faculty for these courses. Since 2009, over ten thousand prescribers in Alabama have successfully completed the Prescribing course.

We also recognized Richard Tucker, a Consultant with Drug Education Consulting Group in Huntsville, NC, and a former U.S. DEA Special Agent for his outstanding contributions. The association bestowed upon him an award in acknowledgment of his eight years of dedicated service in sharing his time and knowledge at the Prescribing of Controlled Drugs Conferences. Tucker’s expertise and commitment have played a pivotal role in enhancing education and awareness surrounding controlled substances, reflecting his significant impact on the medical community’s understanding and responsible prescribing practices.

We were honored to commemorate their achievements. According to recent data released by the American Medical Association, the total opioid prescriptions dispensed in Alabama during their tenure have decreased by 43.7%, and the total dosage strength, measured in morphine milligram equivalents, has decreased by 55.4%. These statistics bear witness to the tangible impact these individuals have had on alleviating the opioid crisis in Alabama.

On behalf of the Board of Censors of the Medical Association of the State of Alabama, and in sincere appreciation of their many years of dedicated leadership, service, and commitment to addressing the opioid crisis in Alabama, we were honored to present them with these well-deserved awards.

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The 11th Circuit Applies SCOTUS Ruling In Recent Alabama Physician Controlled Substances Conviction

The 11th Circuit Applies SCOTUS Ruling In Recent Alabama Physician Controlled Substances Conviction

By: Jim Hoover with Burr & Forman, LLP

On June 27, 2022, the Supreme Court of the United States (SCOTUS) heard an appeal emanating from a conviction of a local doctor in Mobile, Alabama for violating the Controlled Substances Act (CSA).  The justices specifically examined the convictions of Dr. Xiulu Ruan who is serving a prison sentence of more than 20 years. The Government charged Dr. Ruan with unlawfully dispensing and distributing drugs in violation of the CSA.  Dr. Ruan argued that the drugs were dispensed pursuant to a valid prescription, and were for a legitimate medical purpose by him acting in the usual course of his professional practice.  Dr. Ruan further argued that he did not knowingly or intentionally deviate from this standard.

The SCOTUS opinion heavily scrutinized 21 U.S.C. § 841(a), which makes it a federal crime for any person except as authorized to knowingly or intentionally manufacture, distribute or dispense a controlled substance.  As provided by the regulation, a prescription is only authorized when a doctor issues the prescription “for a legitimate medical purpose…acting in the usual course of his/her professional practice.”  The Department of Justice (“DOJ”) argued “knowingly or intentionally” merely refers to the knowing or intentional distribution of a controlled substance.  The SCOTUS held that once a defendant-doctor meets the burden of producing evidence that his or her conduct was “authorized,” the DOJ “must prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner” in order to secure a conviction for improper prescribing.  

The SCOTUS ruled that prosecutors relying on the CSA for excessive prescribing of opioids and other addictive drugs must prove that the doctors knew the prescriptions lacked a legitimate medical purpose.  The SCOTUS vacated the Eleventh Circuit court of appeals opinions and directed it to consider whether the jury instructions given at the conclusion of the trial were consistent with this SCOTUS opinion.  

In an opinion published on January 5, 2023, an Eleventh Circuit panel held that the jury instructions used to convict Dr. Ruan for violating the CSA was inconsistent with the SCOTUS opinion. The Eleventh Circuit panel recognized that in order to obtain a conviction under 21 U.S.C. § 841(a), the government must prove beyond a reasonable doubt that a defendant (1) knowingly or intentionally dispensed a controlled substance, and (2) knowingly or intentionally did so in an unauthorized manner.  “What matters is defendant’s subjective mens rea.”  The Eleventh Circuit panel went on to say that “[W]ithout further qualification, the phrase ‘good faith’ encompasses both subjective and objective good faith. In the context of § 841 though, as the Supreme Court has explicitly held, only the subjective version is appropriate.  The instruction given by the district court did not contain any qualification to make this clear to the jury.”  

The Eleventh Circuit could not conclude that the district court’s error was harmless.  Accordingly, it vacated the defendant-doctor’s substantive drug conviction under 21 U.S.C. § 841(a).  However, the Eleventh Circuit held that the district court’s instructions were proper or any error in the instructions were harmless error as they related to the convictions for (1) conspiracy to violate the CSA, (2) conspiracy to commit health care fraud in violation of 18 U.S.C. §§ 1347 band 1349, (3) violation of the Anti-Kickback Statute, (4) conspiracy to commit mail or wire fraud, (5) conspiracy to violate RICO, and (6) substantive money laundering and conspiracy to commit money laundering.    Thus, the Eleventh Circuit vacated in part and affirmed in part the district court’s ruling and remanded the case to the district court for further proceedings consistent with the Eleventh Circuit’s opinion.

Jim Hoover is a Partner at Burr & Forman LLP practicing exclusively in the firm’s healthcare group. Jim may be reached at (205) 458-5111 or

Posted in: Legal Watch, Opioid

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Opioid Prescriptions in Alabama Fall for 8th Consecutive Year

Opioid Prescriptions in Alabama Fall for 8th Consecutive Year

Contact: Jeff Emerson, 205-540-2247

MONTGOMERY – Alabama physicians are taking action to reduce the number and
potency of opioid prescriptions and to increase access to medication that rapidly
reverses opioid overdoses, according to a new report released Thursday from the
American Medical Association.

The report shows:
Opioid prescriptions in Alabama decreased 41.6 percent from 2012-2021. From
2020-2021, opioid prescriptions in the state declined 1.6 percent, marking the
eighth consecutive year the number of opioid prescriptions in Alabama has
The dosage strength of opioid prescriptions fell 52.7 percent from 2012-2021 and
dropped 6.5 percent between 2020-2021.
Prescriptions of naloxone to treat patients at risk of an opioid overdose rose 851
percent between 2012-2021 and 35.4 from 2020-2021.
Physicians and other healthcare professionals accessed the state’s Prescription
Drug Monitoring Program
more than 5.5 million times in 2021, an increase of
three percent from 2020. Healthcare providers who dispense opioids in Alabama
must report the information to the Prescription Drug Monitoring Program to help
physicians detect the abuse and misuse of prescriptions.

The Medical Association of the State of Alabama was one of the first medical
associations in the country to offer a continuing education course to train physicians on
safely and effectively prescribing opioids. Since 2009, more than 8,000 prescribers in
Alabama have completed the course.

“Alabama physicians are advancing the fight against the opioid crisis by continuing to
reduce the number and potency of prescribed opioids in our state, and by furthering our
education on opioids,” said Dr. Julia Boothe, President of the Medical Association of the
State of Alabama. “While we are making good progress in these areas under a
physician’s control, Alabama is in a worsening overdose epidemic due primarily to
illicitly manufactured fentanyl, which is found in more than 75 percent of counterfeit pills
and other substances. No community is safe from this poison.”

Fentanyl overdose deaths in Alabama increased a staggering 135.9 percent from 2020
to 2021, (453 deaths in 2020 to 1,069 in 2021).

Dr. Bobby Mukkamala, chair of the American Medical Association’s Substance Use and
Pain Care Task Force, said fentanyl is “supercharging” the increase in fatal drug

“What is becoming painfully evident is that there are limits to what physicians can do.
We have dramatically increased training and changed our prescribing habits, reducing
the number of opioids prescribed while increasing access to naloxone, buprenorphine
and methadone. But illicitly manufactured fentanyl is supercharging this epidemic,” said
Dr. Mukkamala.

Resources for Help: Alabamians looking for a list of substance abuse treatment
services can go online to

To read the full report:

Posted in: Official Statement, Opioid

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America’s ‘Other’ Health Emergency Needs Attention Too

America’s ‘Other’ Health Emergency Needs Attention Too

Drug overdose deaths could surpass 100,000 in the U.S. for the first time ever

By John Meigs, Jr., MD

For the past 12 months, the nation’s medical community correctly and understandably focused nearly all its attention on the COVID-19 pandemic.  Now with millions being vaccinated, we are hopefully about to turn the corner and can begin returning our focus to a different health crisis that never went away and actually got worse during COVID.

That crisis is the drug overdose crisis, the epidemic inside the pandemic.

Research shows that more than 13 percent of American adults started or increased substance use to cope with stress related to COVID-19.  Unfortunately, many of the socially isolating steps that were necessary to combat COVID-19 are the same conditions where substance abuse flourishes.  

In Alabama, Jefferson County alone saw drug overdose deaths increase by 25 percent in 2020 to their highest level ever.  This mirrors national data, with the Centers for Disease Control (CDC) reporting the highest number of fatal overdoses ever recorded in the U.S. in a single year in the 12-month period ending in May 2020.  It’s likely the U.S. will surpass 100,000 drug overdose deaths this year for the first time ever.

Fortunately, Alabama is working with the CDC and other states to take statistics like these and turn them into action that ultimately reduces overdose deaths.

Through the Overdose Data to Action program, Alabama is improving its collection of comprehensive and timely information on non-fatal and fatal overdoses.  This helps the state to monitor and understand emerging trends, then drive effective prevention and response solutions tailored to the needs of individuals and communities.

For example, before becoming part of the Overdose Data to Action initiative, Jefferson County received data on overdoses only once a year.  Now it has access to that important information within 24 hours.  With that data in hand, the Jefferson County Department of Health identifies overdose hotspots and mobilizes rapid response teams with physicians, addiction specialists and peer counselors to target recovery and prevention resources to those neighborhoods being hit hardest by drug overdoses.  Plans to replicate this model for other Alabama counties are being developed.

Timely, evidence-based information and collaboration are essential for success in preventing overdose deaths.  First responders, mental health providers, community organizations, public health leaders, medical personnel and others all bring resources and expertise to this effort.

Physicians in Alabama and across America are certainly part of this effort.  We’ve fought to pass legislation to reduce prescription drug abuse and diversion.  Thousands have accessed continuing medical education and other intensive courses on substance use disorders.  In fact, the Medical Association of the State of Alabama was one of the first in the nation to offer an opioid prescribing education course.  Since 2009, we have reached more than 5,000 prescribers with information on the safe prescribing of opioids.  Since 2018, the number of times health care professionals in Alabama have accessed the state’s Prescription Drug Monitoring Program has increased by more than 20 percent, and Alabama physicians have reduced their prescriptions of opioids by more than 34 percent since 2014.  

All these collaborative efforts and more are needed as our nation’s drug overdose crisis evolves into an even more complicated and dangerous epidemic, due primarily to the pervasiveness of fentanyl.

Overdose deaths involving prescription opioids have steadily declined, but overdose deaths related to illicitly manufactured fentanyl and related fentanyl analogs increased nationwide by more than 500 percent between 2015 and 2019, according to the CDC.

Fentanyl, a painkiller that is 100 times more powerful than morphine, is the number one cause of overdose deaths in the United States today.  So powerful and lethal is fentanyl that if you were to swallow, inhale or absorb just two milligrams of it through your skin, you would die.  To appreciate just how small two milligrams is, consider that the packet of sweetener you’ll find on most restaurant tables is about 1,000 milligrams.

When police in Brookwood recently seized two pounds of fentanyl during a traffic stop, the former U.S. attorney who said it was enough to kill nearly every resident of Jefferson County was not exaggerating.

For years, fentanyl has been mixed with illegal drugs like heroin.  Today, however, we are seeing more instances where fentanyl is pressed into counterfeit pills to resemble prescription opioids.  Such was the case in Muscle Shoals last year where police found pills that were being sold by a drug dealer as Oxycodone but were actually pure fentanyl.  This takes the drug overdose crisis to a new and more dangerous level.  Everyone who obtains any drug from an illicit source should know they are at tremendous risk of a fatal fentanyl overdose. 

With the number of new COVID cases and deaths finally heading in the right direction, we must renew our attention and focus on America’s “other” health emergency, the overdose epidemic.  Significant efforts by health professionals, advocates, law enforcement and government are being made to address this crisis.  With even more attention, collaboration and resources, countless lives can be saved.


Dr. Meigs has practiced family medicine in Bibb County for more than 30 years and serves as President of the Medical Association of the State of Alabama.

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Report: 34 Percent Decline in Opioid Prescribing since 2014

Report: 34 Percent Decline in Opioid Prescribing since 2014


CONTACT: Mark Jackson, Executive Director (334) 954-2500

CONTACT: Mallory Camerio, Director of Communications (334) 954-2580

Report: 34 Percent Decline in Opioid Prescribing since 2014

According to a new report released by the American Medical Association, Alabama physicians have reduced opioid prescribing by 34.4% since 2014, increased the use of state prescription drug monitoring programs (PDMP) and decreased the total morphine milligram equivalents by 46.6% since 2014. Our physicians also have continued to educate themselves on safe prescribing, pain management and recognizing signs of addiction. 

“Everyone can agree there is no quick fix to the country’s opioid epidemic. In Alabama, our physicians took a leadership role many years ago by taking a hard look at where we were and where we needed to be,” said Mark Jackson, executive director of the Medical Association of the State of Alabama. “As an association, we created the first educational program to train our physicians, and we passed legislation to reduce prescription drug abuse and diversion. Even though Alabama has come a long way in the fight against opioids, we have a long way yet to go.”

Key points from the 2020 report:

  • Opioid prescribing decreases for the sixth year in a row. Between 2013 and 2019, the number of opioid prescriptions decreased by more than 90 million — a 37.1 percent decrease nationally.
  • Total morphine milligram equivalents has decreased by 46.6% since 2014 in Alabama.
  • Prescription Drug Monitoring Program (PDMP) registrations and use continue to increase. In 2019, health care professionals in Alabama accessed state PDMPs more than 4 million times – a 20 percent increase from 2018. More than 22,500 physicians and other health care professionals are registered to use state PDMPs.
  • The Medical Association was one of the first states to offer an opioid prescribing education course in the country in 2009. The main course is offered three times each year and has reached more than 5,000 prescribers to date.
  • Access to naloxone increasing. More than 1 million naloxone prescriptions were dispensed in 2019—nearly double the amount in 2018, and a 649 percent increase from 2017. In 2016 the Medical Association helped pass legislation in Alabama authorizing the State Health Officer to sign a standing order to allow Alabama’s pharmacists to dispense naloxone to people in a position to assist others at risk of an overdose as well as to an individual at risk of experiencing an opiate-related overdose.


Posted in: Official Statement, Opioid

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Alabama Hospitals File Suit Against Opioid Manufacturers, Distributors

Alabama Hospitals File Suit Against Opioid Manufacturers, Distributors

Hospitals experience significant financial and operational harm as opioid crisis continues

EVERGREEN, Ala., Sept. 10, 2019 /PRNewswire/ — After two decades of providing frontline care in response to the opioid crisis, a group of 21 Alabama hospitals have filed a civil lawsuit in Conecuh County Circuit Court against the manufacturers, distributors, and retailers of opioid-based drugs. As the opioid crisis has reached epidemic levels, Alabama hospitals have made substantial investments in people, processes and facilities to properly care for patients who have multiple health problems associated with treating the complications of opioid addiction.

The complaint alleges defendants engaged in a decades-long practice of making false assurances about the addiction risks associated with opioid products and used other deceptive marketing tactics to persuade physicians and health care providers to broaden prescribing patterns. The result has been widespread addiction, suffering, and loss of life in communities across Alabama and the nation, with hospitals bearing the financial burden of care and treatment for the victims.

In 2017, 107.2 opioid prescriptions were written for every 100 people in Alabama, the highest prescribing rate in the country and nearly twice as high as the national average of 58.7 per person. There were 167 deaths involving prescription opioids in Alabama in 2017, an increase from 124 in 2016.

“The deceptive marketing efforts of the defendants substantially contributed to an explosion in the use of opioids across the country – and the aftereffects are felt in hospitals every single day,” said Robert King, attorney with The King Law Firm, representing the hospitals. “Hospitals have provided heroic levels of care to opioid-addicted patients and saved countless lives. But the financial, operational and emotional expense for hospitals is staggering. The defendants are at the root of this crisis.”

Industry analysts estimate the country’s healthcare system incurred more than $215.7 billion in costs related to the opioid crisis from 2001 to 2017. The costs were largely attributable to overdose-related emergency department visits.

The hospitals’ complaint alleges negligence, fraud and civil conspiracy by the defendants, which include Purdue Pharma, Johnson & Johnson, Abbott Laboratories and more than 40 other companies and individuals involved in the manufacturing, distribution, and sales of prescription opioids.

“With the appropriate financial resources, no party is better positioned to lead us out of this public health crisis than hospitals,” said Stephen Farmer, attorney with Farmer Cline & Campbell PLLC.

“Hospitals have experienced significant, measurable damages and must be active participants in any opioid settlement discussions,” adds Farmer, who serves as additional counsel for the plaintiffs.

Last month, former Ohio Governor John Kasich and West Virginia University President Dr. Gordon Gee recognized hospitals’ unique position to positively impact the opioid crisis by announcing the formation of Citizens for Effective Opioid Treatment at The 501(c)(4) organization is working to educate business and community leaders and the public about the negative impact the crisis is having on the nation’s health care infrastructure while advancing evidence-based solutions to the opioid epidemic.

Also last month, the American Hospital Association urged a judge hearing one of the opioid cases “to ensure that needed funds are directed to the hospitals and health systems that are on the forefront of caring for the victims of this epidemic. With additional resources, hospitals can broaden access to post-overdose treatment in emergency departments, increase training of physicians to treat substance use disorders, cover the costs of lengthy stays and follow-up care for infants with neonatal abstinence disorder, and invest in electronic health information systems to improve coordinated care and prevent overprescribing.”

The Alabama hospitals join hundreds of other hospitals across the country that have filed similar suits against opioid manufacturers and distributors.

The Alabama hospitals who filed suit this month include:

  • DCH Health Care facilities in Tuscaloosa, Northport and Fayette
  • Baptist Health medical centers in Montgomery and Prattville
  • Medical West in Bessemer
  • Evergreen Medical Center in Evergreen
  • Jackson Medical Center in Jackson
  • Flowers Hospital in Dothan
  • Medical Center Enterprise in Enterprise
  • Grandview Medical Center in Birmingham
  • Gadsden Regional Medical Center in Gadsden
  • South Baldwin Regional Hospital in Foley
  • Grove Hill Memorial Hospital in Grove Hill
  • Princeton Baptist in Birmingham
  • Walker Baptist Medical Center in Jasper
  • Shelby Baptist Medical Center in Alabaster
  • Citizens Baptist Medical Center in Talladega
  • Brookwood Baptist in Birmingham

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Opioid Use Decreased in Medicare Part D While MAT Increased

Opioid Use Decreased in Medicare Part D While MAT Increased

The nation has been grappling with an opioid crisis for years. In 2017 alone, there were 47,600 opioid-related overdose deaths in the United States. It continues to be a public health emergency. U.S. Department of Health & Human Services Office of the Inspector General has been tracking opioid use in Medicare during this crisis, particularly since 2016.

In a statement, the Centers for Medicare & Medicaid Services said: “Fighting the opioid epidemic has been a top priority for the Trump administration. We are encouraged by the OIG’s conclusion which finds significant progress has been made in our efforts to decrease opioid misuse while simultaneously increasing medication-assisted treatment in the Medicare Part D program.”

OIG has identified beneficiaries at serious risk of misuse or overdose and has identified prescribers with questionable prescribing for these beneficiaries. These types of analyses are crucial to understanding and addressing the national opioid crisis. Building on past OIG work, this data brief details opioid use in Medicare Part D in 2018 and trends in drugs used to treat opioid use disorder.

We based this data brief on an analysis of Part D prescription drug event records for opioids received in 2018. We determined the beneficiaries’ morphine equivalent dose, which is a measure that converts all of the various opioids and strengths into one standard value.


Alabama had the highest proportion of beneficiaries receiving opioids through Medicare Part D, while Hawaii had the lowest proportion.

  • Nearly 3 in 10 Medicare Part D beneficiaries received opioids in 2018, a significant decrease from the previous 2 years.
  • At the same time, the number of beneficiaries receiving drugs for medication-assisted treatment for opioid use disorder has steadily increased and reached 174,000 in 2018.
  • In addition, the number of beneficiaries receiving prescriptions through Part D for naloxone-a drug that can reverse the effects of an opioid overdose-more than doubled from 2017 to 2018.
  • About 354,000 beneficiaries received high amounts of opioids in 2018, with about 49,000 of them at serious risk of opioid misuse or overdose; this was fewer than in the previous 2 years.
  • About 200 prescribers had questionable opioid prescribing for beneficiaries at serious risk.


Progress has been made in decreasing opioid use in Part D, increasing the use of drugs for medication-assisted treatment, and increasing the availability of naloxone. It is imperative for the Department of Health and Human Services-including CMS and OIG-to continue to implement effective strategies and develop new ones to address this epidemic.

Read the complete Data Brief

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STUDY: Risk of Suicide Attempt by Children Doubles if Parent Uses Opioids

STUDY: Risk of Suicide Attempt by Children Doubles if Parent Uses Opioids

The suicide rate among young people in the U.S. has risen dramatically in the past 15 years. Over the same time period, opioid use and abuse in adults also has increased considerably. Researchers from the University of Chicago and the University of Pittsburgh reported on a connection between these two epidemics in a study published this week in JAMA Psychiatry.

“Until now, there has been little focus on the association between the increase in opioid use among adults and the risk of suicidal behavior by their children,” said Robert D. Gibbons, PhD, the Blum-Riese Professor of Biostatistics and director of the Center for Health Statistics at UChicago and senior author of the paper. “We theorized such a link was plausible because parental substance abuse is a known risk factor for suicide attempts by their children. In addition, depression and suicide attempts by parents — which are known to be related to suicidal behavior in their offspring — are more common among adults who abuse opioids.”

The researchers analyzed data from more than 240,000 parents, ages 30 to 50, between 2010 and 2016. Half of the group had filled opioid prescriptions for at least 365 days. The other half had no history of using the drug during that time. The two groups were matched on a number of factors related to suicide attempts and opioid use. Rates of suicide attempts were studied in over 330,000 children, ages 10 to 19, from these two groups of parents over the same six-year period.

Of the children whose parents used opioids, 678 (0.37%) attempted suicide. Of the sons and daughters of parents who did not use opioids, 212 (0.14%) made a suicide attempt. The researchers found that opioid use by a parent is associated with a doubling of the risk of suicide attempts by their children. The results were statistically significant even when adjusted for child age and sex, depression or substance use disorder in child or parent, and history of a suicide attempt in a parent.

“These findings demonstrate that opioid use by a parent or parents doubles the risk for suicidal behavior by their children,” said David A. Brent, MD, psychiatrist and chair of suicide studies at the University of Pittsburgh, also an author on the paper. “The epidemics of adult opiate abuse and child suicidal behavior appear to be linked, and the disturbing upward trends in mortality due to opiates and due to child suicide may have common roots.”

Gibbons and Brent call for improved diagnosis and treatment of parents who use opioids as well as mental health screening and referral to care for their children. “These actions could help reverse the upward trend in deaths due to the twin epidemics of suicide and opioid overdose,” Gibbons said.

The study, “Association Between Parental Medical Claims for Opioid Prescriptions and Risk of Suicide Attempt by Their Children,” was supported by a grant from the National Institutes of Health. Kwan Hur, PhD, in the Center for Health Statistics at the University of Chicago, was also an author of the study.

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CDC Clarifies Opioid Prescribing Guidelines

CDC Clarifies Opioid Prescribing Guidelines

Since the Centers for Disease Control and Prevention released its Guidelines for Prescribing Opioids for Chronic Pain in 2016, physicians have relied on the document for recommendations when prescribing pain medication to their patients. However, because the CDC did not specifically clarify the guidelines in the original release, many physicians’ groups have been concerned the guidelines were misapplied to the detriment of pain patients.

The CDC issued the guideline in March 2016 in an attempt to curb widespread opioid abuse, which claimed more than 20,000 U.S. lives in the previous year along. The guideline was intended for primary care clinicians and advised them to prescribe treatments other than opioids for chronic pain outside of active cancer treatment, palliative care and end-of-life care.

Three years later, more than 300 health care professionals wrote to the CDC urging clarification of the guideline and suggesting the possibility it is being misapplied by physicians and insurers, and even harming patients. The letter was signed by prominent medical experts, including three former White House “drug czars” who served in the Obama, Clinton and Nixon administrations. The University of Alabama at Birmingham School of Medicine’s Professor Stefan G. Kertesz, M.D., is also one of the signees of the letter.

“We urge the CDC to issue a bold clarification about the 2016 guideline — what it says and what it does not say, particularly on the matters of opioid taper and discontinuation,” the group wrote in the letter, which was also sent to leaders of the House Committee on Energy and Commerce and the Senate Committee on Health Education Labor and Pensions.

In a letter released publicly in April, the CDC said the guidelines were not intended to deny chronic pain patients relief from opioids and encouraged physicians to use their “clinical judgment” in prescribing the medications, which can be addictive. The letter also spoke specifically to the use of opioids in the treatment of cancer and sickle cell patients, making it clear the guideline was not meant to limit access to pain management for patients with these conditions.

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Drug Overdoses in Young People on the Rise

Drug Overdoses in Young People on the Rise

PISCATAWAY, NJ – In American adolescents and young adults, death rates from drug poisoning, particularly from opioids, have sharply increased over the last 10 years, according to new research in the Journal of Studies on Alcohol and Drugs.

In 2006, the death rate from drug poisoning from any type of legal or illicit drug was 8.1 deaths for every 100,000 people in the population ages 15 to 24. This rose to 9.7 per 100,000 by 2015, mainly fueled by deaths from opioid use. In this age group, death rates from opioids — both prescription opioids and illicit opioids such as heroin — rose 4.8 percent on average annually from 2006 to 2015, with an even steeper incline of 15.4 percent a year between 2013 and 2015.

“The surge in drug poisoning deaths . . . among adolescents and young adults reflects the ease of access to pharmaceutical drugs, especially prescription opioids . . . and later transition to more potent opioids,” the authors write. Many young people are introduced to opioids through prescription drugs, such as Vicodin or OxyContin. They often misuse these drugs with motivations to relieve pain, relax, feel good, or get high.

“[W]hen people addicted to prescription opioids face difficulty accessing these drugs because of tighter controls, they often turn to increasingly available and cheaper heroin,” the authors continue. Those who switch from prescription drugs to heroin are at high risk for drug overdose because these individuals are “accustomed to titrated prescription drugs and do not realize that heroin varies in potency and can be cut or mixed with dangerous and potentially deadly substances,” such as fentanyl.

To conduct their study, researchers led by Bina Ali, Ph.D., of the Pacific Institute for Research and Evaluation in Maryland, analyzed mortality data from the National Center for Health Statistics from 2006 through 2015. In addition to examining average annual rate changes in drug poisoning death rates for adolescents (ages 15-19) and young adults (ages 20-24), Ali and her colleagues estimated the costs to society associated with these deaths. This included the costs of medical interventions (emergency transport; treatment in hospitals, nursing homes, and hospices; and autopsies), work loss (loss of earnings and household work that young people would have made over the remainder of an average life), and quality-of-life loss (the monetary value of intangible losses such as pain and suffering).

The investigators found that drug poisoning death rates in adolescents and young adults were higher for Whites (11.9 for every 100,000 people) and American Indian/Alaskan Natives (10.0) compared with Blacks (2.6), Asian/Pacific Islanders (2.3), and Hispanics (4.0). Over time, the rates significantly increased for Whites (1.7 percent per year from 2006 to 2015), Asian/Pacific Islanders (4.3 percent per year from 2006 to 2015), and Blacks (11.8 percent per year from 2009 to 2015).

Drug poisoning death rates in adolescents and young adults vary by state. For example, the rate in West Virginia was approximately 5 times higher than the rate in Nebraska (15.1 vs. 3.1 per 100,000). When looking at changes between 2006 and 2015, New York had the highest increase in drug poisoning death rate, with a 9.4 percent increase each year. This was followed by Ohio, Massachusetts and New Jersey (with 9.1 percent, 9.0 percent and 8.7 percent increases annually, respectively).

The estimated costs of drug poisoning deaths among young people in the United States were $27.1 million in medical costs, $8.5 billion in work loss costs, and $26.5 billion for quality-of-life loss in 2015.

“The burden of drug poisoning deaths among adolescents and young adults is substantial,” Ali and her colleagues conclude. “With the burden of drug poisoning deaths among adolescents and young adults estimated at $35.1 billion nationally, targeted state-specific efforts are warranted.”

Evidence-based and promising strategies exist, such as knowledge and skills development for physicians, young people, and their parents; expansion of prescription drug monitoring programs, prescription drug disposal methods, and naloxone distribution programs; and medication-assisted treatment that combines medications with counseling and behavioral therapies. Interventions that are tailored for high-risk populations and directed at multiple levels (individuals, communities, and public health systems) are needed to reduce premature deaths from drug overdoses, according to Ali.


Ali, B., Fisher, D. A., Miller, T. R., Lawrence, B. A., Spicer, R. S., Swedler, D. I., & Allison, J. (2019). Trends in drug poisoning deaths among adolescents and young adults in the United States, 2006-2015. Journal of Studies on Alcohol and Drugs, 80, 201-210. doi:10.15288/jsad.2019.80.201

The Journal of Studies on Alcohol and Drugs is published by the Center of Alcohol Studies at Rutgers, The State University of New Jersey. It is the oldest substance-related journal published in the United States.

To learn about education and training opportunities for addiction counselors and others at the Rutgers Center of Alcohol Studies, please visit

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