20th century

1911 to 1990’s

Opioid pain medications were used primarily for acute pain and cancer pain. Studies showing inadequate treatment of chronic non-cancer pain by physicians lead to an increased use of opioids.

21st century

Early 2000’s

Reports of overdose and death from prescription drug products, especially opioids, began to rise sharply, with OxyContin at the center of the problem. For instance, the number of people who admitted to using OxyContin for non-medical purposes increased dramatically from approximately 400,000 in 1999 to 1.9 million in 2002 and to 2.8 million in 2003.

By 2009, about 1.2 million emergency department (ED) visits were related to misuse or abuse of pharmaceuticals, an increase of more than 98% since 2004 and more than the number of ED visits related to use of illicit drugs such as heroin and cocaine. Most prominent among these prescription drug-related deaths and ED visits were opioid pain relievers (OPR), especially OxyContin.

FDA had worked with sponsors for more than a decade to implement risk management programs for a number of opioid products. However, data demonstrated that these programs did not adequately manage the risks of misuse, abuse, addiction, and overdose. More was needed.

2010

The FDA approved a new formulation of OxyContin

2011

As part of a three-year inter-agency agreement with the Department of Justice’s Bureau of Justice Administration and in collaboration with the CDC, FDA provided funding to support efforts by the Prescription Drug Monitoring Program Center of Excellence at Brandeis University. The effort was to develop a national database of state PDMP data to be used for surveillance of emerging problems or concerns with scheduled drugs and to examine the impact of national, state and community initiatives implemented to curb misuse, overuse, and abuse of opioids.

2012

FDA awarded funding for up to three years for three cooperative agreement grants to examine strategies and interventions and their potential to impact opioid analgesic misuse and abuse. The following research topics were funded:

· Examine the prescribing habits of physicians who prescribe doses of opioids above 100 mg morphine equivalents per day and/or prescribe opioids in combination with benzodiazepines.

· Examine the clinical use of different tools that can guide a clinician in prescribing opioids and reduce patient misuse, overuse, and abuse of opioids.

· Estimate the incidence of urine drug testing (UDT) during the year following initiation of chronic opioid therapy (COT) and identify demographic, clinical, provider, and facility variables associated with the use of UDT within the national Veterans Affairs (VA) healthcare system.

2013

Governor Mary Fallin signed a bill into law, taking effect November 2013, banning refills on prescriptions for hydrocodone products. The law applies to both in-state and nonresident pharmacies. The penalties for violating the new law include license suspension, probation or revocation, and fines of up to $3,000 per occurrence.

FDA took multiple actions related to OxyContin.

2014

FDA approved Evzio (naloxone hydrochloride injection) for the emergency treatment of known or suspected opioid overdose. Naloxone is a medication that rapidly reverses the effects of opioid overdose. Evzio is the first auto-injector designed to deliver a dose of naloxone outside of a healthcare setting.

2015

The FDA, in collaboration with the National Institutes of Drug Abuse, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, and the Health Resources and Services Administration, held a scientific workshop to initiate a public discussion about issues surrounding the uptake of naloxone in certain medical settings – such as on ambulances and in association with prescriptions for opioids – as well as outside of conventional medical settings to reduce the incidence of opioid overdose fatalities. Discussions focused on which populations are at risk for opioid overdose; how public health groups can work together to use naloxone to reduce the risk of overdose; and legal, regulatory, logistical and clinical aspects related to making naloxone more widely available.

2016

The FDA leaders, in response to the opioid abuse epidemic, called for a far-reaching action plan to reassess the agency’s approach to opioid medications. The plan will focus on policies aimed at reversing the epidemic, while still providing patients in pain access to effective relief.

2017

The FDA released the "FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain” which broadens the current Blueprint to include information on pain management, including the principles of acute and chronic pain management; non-pharmacologic treatments for pain; and pharmacologic treatments for pain (both non-opioid analgesic and opioid analgesic). After studying other state and national recommendations, the Opioid Prescribing Guidelines for Oklahoma Workgroup created guidelines for Oklahoma prescribers in 2017. The guidelines were developed to help improve communication between clinicians and patients about the risks and benefits of opioid therapy for pain management, 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, while preserving patient access to needed medical treatment.

2018

May:

Senate Bill 1446 passed and went into effect on November 1st, 2018. This bill places limits on the number of opioid pills that a physician can prescribe. Physicians will only be able to initially prescribe a week's worth of opioid drugs to manage acute pain and must limit the dosage to the lowest effective dose. Before renewing the prescription for up to seven more days, the law requires a consultation with the patient to determine that the patient needs the prescription and that the prescription does not present a risk for abuse, addiction, or diversion. If after the initial 14 days the physician determines that the patient still needs opioids to manage pain, the physician must follow the procedures to treat chronic pain.

House Bill 2931 also passed and went into effect on January 1, 2020, requiring all physicians with prescriptive authority (other than veterinarians) to send all scheduled drugs electronically. The measure provides that a Schedule V controlled substance may not be filled or refilled more than 5 times after the date of the prescription.

FDA Commissioner, Scott Gottlieb, M.D., announced the 2018 Strategic Policy Roadmap, which provides an overview of some of the key priorities the agency will pursue advance FDA’s public health mission. Part of the Roadmap is reducing misuse and abuse of opioid drugs. FDA took action against 74 websites marketing unapproved opioids as part of a comprehensive effort to target illegal online sales. The Opioid Prescribing Guidelines for Oklahoma Workgroup partnered with the Oklahoma Perinatal Quality Improvement Collaborative (OPQIC) Oklahoma Mothers and Newborns affected by Opioids (OMNO) Project to form a multidisciplinary sub-workgroup called the Opioid Prescribing and Pregnancy Workgroup. This sub-workgroup aims to address the use of opioids for pain management in pregnant patients and the treatment of pregnant patients with opioid use disorder to improve patient outcomes.

2019

FDA approved first generic naloxone nasal spray to treat opioid overdose. FDA launched a public education campaign to encourage safe removal of unused opioid pain medicines from homes. Massachusetts Attorney General makes public lawsuit against Purdue for continuing to mislead regulators and contributing to the opioid crisis.

2020

US Center for Disease Control (CDC) provides thorough guidelines and regulations regarding the prescription of opioids treatments for chronic pain. While opioid treatment for such pain can be successful and beneficial if controlled, the CDC has encouraged medical professionals to select non-opioid treatments as a primary step, while opioid-based medications should only be used following a careful assessment and with regular evaluations of need. Naloxone is another method used to fight the opioid crisis. Naloxone is an overdose-reversal drug designed to help reduce the number of deaths caused as a result of opioid addiction, and many states have enacted laws in recent years requiring Naloxone to be available. The US Department of Health & Human Services announced a strategy to further curb the opioid crisis. This included a range of solutions that deliver a more accessible treatment center option, increase awareness and public surveillance to help enhance understanding of the dangers of opioid addiction, and also give support to research on treating pain and addiction.

The Facts

• 28,898 Oklahomans admitted to Treatment for Prescription Drug Addiction from 2014 to 2018. (ODMHSAS)

• 4,190 Oklahomans were hospitalized due to a non-fatal opioid overdose from 2012 to 2016. (ODMHSAS)

• In 2018, Oklahoma providers wrote 79.1 opioid prescriptions for every 100 persons–compared to average U.S. rate of 51.4 prescriptions.

More data available from our partners at Think SMART Oklahoma and Prescription For Change

Social Legal and Health Consequences

Coming soon!

Opioids and Teens

Opioid misuse among teenagers is becoming a growing problem. Mental Health Services Administration listed behavior signs and symptoms of opioid addiction among adolescents as:

1. a change in peer group,

2. carelessness with grooming,

3. decline in academic performance,

4. missing classes or skipping school,

5. loss of interest in favorite activities,

6. changes in eating or sleeping habits,

7. and deteriorating relationships with family and friends.

Young adults are especially vulnerable to the dangers of addiction, and through increased education during formative years and prescription discretion by healthcare providers, Oklahoma youth can be both pain and addiction free.

Opioids and Pregnancy

A message from Attorney General Mike Hunter, December 31, 2019

“Avy Redus, Project Coordinator for Unintentional Poisoning and Prescription Drug Overdose Prevention Programs within Injury Prevention Services at the Oklahoma Department of Health, presented to the group regarding Neonatal Abstinence Syndrome (“NAS”). She explained that substance use disorder in pregnant women has increased by more than four times since 1999, and four times the amount of infants are now born with NAS. Ms. Redus explained substance use by pregnant women is causing devastating effects on these babies, with a baby born every 25 minutes that is suffering from opioid withdrawal.”

To read more from the Attorney General's Opioid Commission Report, please visit the link below.

AG Opioid Commission Report

See more information on this subject in the Resources section.

Opioids and Athletes

Coming soon!

Opioids and Road Safety

If you take medications routinely, its important to know the risks for interactions that may impact your safety on Oklahoma's Roadways. Visit AAA's RoadwiseRx app to give it a test drive.

Opioid Testimonials

Coming soon!

CDC- Opioid Overdose Info

SAMHSA Overdose Prevention Toolkit

Prescription for Change

Think SMART Oklahoma

OK State Dept. of Health

Naloxone Resources

RESOURCES COMING SOON