National Perspective

Over the past few years, the federal government has made a noticeable investment in fighting opioid abuse. Traditionally this subject was the purview of federal agencies such as the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), or even the Veteran’s Administration (VA). Yet recently, the Centers for Disease Control and Prevention (CDC) has emerged as an agency committed to this issue, with the funding to match. According to the CDC, there are a variety of ways to help reduce exposure to opioids and prevent abuse, which include prescription drug monitoring programs, enhancing State prescription drug laws, quality improvement programs in health care systems to increase implementation of recommended prescribing practices, and youth substance abuse prevention. 

It is the CDC’s goal to improve prescribing of opioids, expand treatment of addiction, and reduce access to illegal opioids. They wish to expand access to evidence-based substance abuse treatment, such as medication-assisted treatment (MAT), for people already struggling with opioid addiction. Another goal is to expand access and use of naloxone. They also wish to promote the use of state prescription drug monitoring programs (PDMPs), which give health care providers information to improve patient safety and prevent abuse, and implement and strengthen state strategies that help prevent high-risk prescribing and prevent opioid overdose.

Most of the new funding has gone to the National Center for Injury and Control. Two years ago, their budget for opioid overdose was just over $20 million. In fiscal year 2016, that jumped to $70 million. Another increase of $20 million was recommended for 2017, but due to no appropriations bills being passed, it remains at $70 million under a continuing resolution. In fiscal year 2016, California received $9.5 million in Injury Prevention and Control funding (CDC, 2016a).

One of the key programs managed by this center is funding that goes to states to enhance prevention, especially in the form of PDMPs. California is one of sixteen states that is funded through this program, having submitted a successful application (CDC, 2016c). The purpose of the Prevention for States program is to provide state health departments with resources and support needed to advance interventions for preventing prescription drug overdoses. Through 2019, CDC plans to give selected states annual awards between $750,000 and $1 million to advance prevention in four key areas (CDC, 2016c). Awarded states are collaborating with key partners to maximize efforts and address issues that impact prescribing and drug overdoses. In addition to funding PDMPs, states are encouraged to undertake policy evaluations and develop raid response techniques. 

The CDC’s foray into the complications of addiction is not new, however. For decades they have been funding research and grants aimed at fetal alcohol spectrum disorders (FASDs), led by their National Center on Birth Defects and Developmental Disabilities (NCBDDD). They monitor patterns of alcohol use across the country, especially amongst women of child-bearing age. They seek to reduce alcohol use and alcohol exposed pregnancies through community level guided self-change, which tend to be of low intensity as compared with traditional treatments, targeted toward the community at large, and focused on problem drinkers as opposed to severely alcohol-dependent drinkers (CDC, 2016b). The goal of these programs is to attract and assist motivated individuals in the early stages of alcohol abuse to take part in an intervention aimed at facilitating a client-driven, self-change process of alcohol reduction or abstinence. In the last several fiscal years, California has received millions of dollars’ worth of grants to work on this issue. Last year, the University of California was funded to enact a FASD Regional Training and Practice Centers ($275,000), as well as a FASD Practice and Implementation Center High-Impact Projects for Practice ($151,200; CDC, 2017a).

Perhaps the CDC effort that has gained the most recognition in the last year is the CDC’s prescribing guidelines. The 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 aged eighteen and older in primary care settings (CDC, 2017b). Recommendations focus on the use of opioids in treating chronic pain—that is, pain lasting longer than three months or past the time of normal tissue healing—outside of active cancer treatment, palliative care, and end-of-life care.

This guideline addresses when to prescribe opioid treatment for chronic pain, as well as opioid selection, dosage, duration, follow-up, and discontinuation. It also covers assessment of risk and addressing harms of opioid use. For the guideline, the CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee (CDC, 2017b). This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. 

The CDC is critical to our nation’s collective health. Its contributions to fighting addiction are no exception, and we will continue to support their initiatives throughout the budget process.

Centers for Disease Control and Prevention (CDC). (2016a). Centers for Disease Control and Prevention fiscal year 2016 grants summary profile report for California. Retrieved from https://wwwn.cdc.gov/FundingProfilesApp/Report_Docs/PDFDocs/Rpt2016/California-2016-CDC-Grants-Profile-Report.pdf

Centers for Disease Control and Prevention (CDC). (2016b). Fetal alcohol spectrum disorders (FASDs): About us. Retrieved from https://www.cdc.gov/ncbddd/fasd/about.html

Centers for Disease Control and Prevention (CDC). (2016c). Opioid overdose: Prevention for states. Retrieved from https://www.cdc.gov/drugoverdose/states/state_prevention.html

Centers for Disease Control and Prevention (CDC). (2017a). Fetal alcohol spectrum disorders (FASDs): Training and education. Retrieved from https://www.cdc.gov/ncbddd/fasd/training.html

Centers for Disease Control and Prevention (CDC). (2017b). Opioid overdose: CDC Guideline for prescribing opioids for chronic pain. Retrieved from https://www.cdc.gov/drugoverdose/prescribing/guideline.html