Now is not the time for the CDC to relax opioid prescription guidelines

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This month, the Centers for Disease Control and Prevention (CDC) released their 2022 Clinical practice guideline for prescribing opioids for pain. The report is an update of the previous one Guidelines 2016, but take a step back in the national fight against the opioid crisis.

Dr. Kenneth A. Scheppke, Florida Deputy Secretary of Health, wrote the response below. This was published in the Wall Street Journal on November 21, 2022.


The US has been grappling with the opioid crisis for nearly two decades.

In 2020, more than 90,000 Americans died of drug overdoses, with 75% of these deaths involving opioids. In 2020, more Americans ages 18 to 45 died from drug overdoses than car accidents and suicide combined.

Opioid use disorder is a chronic, life-threatening illness that people contract from exposure to opioids, either illegal or prescribed by a doctor. In recognition of this, in 2016 the Centers for Disease Control and Prevention highlighted the risks of overprescribing and the need to limit opioid prescriptions to three days for acute pain. It also advised doctors not to increase the dosage beyond 90 milligrams of morphine per day.

Still, in early November, the CDC updated its clinical practice guideline for prescribing opioids for pain. The updated recommendations remove the limitation of opioid treatment to three days and remove the dosing recommendation. The accompanying 2022 report even says: “Opioids may be essential drugs for pain management; however, they carry significant potential risk.

“Potential risk? The 2016 report described opioids as having “serious risks, including overdose and opioid use disorder.” There is nothing potential about it. While opioids may be necessary for serious conditions and end-of-life care, the general public should not be told that they are “essential” for pain management.

Many healthcare professionals who have come into the practice in recent decades will identify with episodes of the Hulu series “Dopesick,” which tells the story of the dark years before the dangers of opioids were understood. The overprescription of opioids has led to addiction and dependence on illicit drugs. In one study, 80% of heroin users reported that they started this illicit drug use after being given opioids. Therefore, the warning to prescribers should be that prescriptions are often the pathway to illicit drug addiction and have contributed to the fentanyl crisis. I suspect many doctors will wonder why the new report is reversing sound advice and minimizing the clear and proven danger of opioids.

In Florida, we’ve made great strides in understanding this disease and the need for non-opioid pain therapy. Our state has taken aggressive steps to combat the deadly opioid crisis through evidence-based treatment while ensuring that those who knowingly contribute to the spread of this disease are held accountable.

Yet there has been an explosion of the deadly fentanyl in our state, both as a replacement for older illegal opioids and as an additive in many other street drugs. Since 2015, fentanyl overdose deaths in Florida have increased by 790%.

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In response to these alarming statistics, Governor Ron DeSantis signed legislation earlier this year that increased penalties for criminals selling this toxin in our communities and developed Florida’s Coordinated Opioid Recovery, or CORE, Network to help victims who suffer from a disorder in the use of resources.

CORE Network recognizes substance use disorder as a chronic, lifelong illness. Overdose is a symptom of that disease. To disrupt the revolving door of overdose and recovery among people with substance use disorders, CORE Network links overdose cases with resources for long-term sustainable recovery. If someone in a CORE county overdoses, the 911 protocol begins stabilization while the patient is transported to a specialty hospital with expertise in addiction medicine. Once all emerging health threats are stabilized, long-term patient care needs are identified and supported. Patients are then connected to organizations that support sustainable recovery, including access to medication-assisted treatment, primary care, dental care, workforce development and more.

The CORE Network requires no overdose to access sustainable care services and provides the means to obtain tailored, evidence-based care to support lifelong recovery. Florida is working around the clock to extend this treatment model to standard care for recovery.

The nation has taken action to address this man-made catastrophe of opioid addiction, placing a significant portion of the blame squarely on drug companies. With approximately $50 billion in global opioid recovery fund settlements, we are on track to obtain the resources we need to end this deadly epidemic.

The opioid crisis was caused by greed. The healthcare system was led to believe that these drugs were safe. Pharmaceutical companies have fraudulently convinced governments of safety. Patients were overprescribed these substances, with disastrous consequences. We are beginning to learn from our mistakes, lessen the stigma, recognize this condition for the brain disease it is, and take steps toward a brighter future. Now is not the time for the CDC to relax its opioid recommendations.


Dr. Kenneth A. Scheppke is a licensed physician who is also a dual board certified specialist in emergency medicine and the subspecialty of EMS. Dr. Scheppke received his medical degree from the Renaissance School of Medicine at Stony Brook University. He completed his internship and residency at the Delaware Medical Center where he was elected Chief Resident.

Dr. Scheppke has over 25 years of extensive experience in EMS, and his contributions to the field have earned him national recognition and awards. A major key achievement is his leadership in the development of the CORE network, which was initially piloted in Palm Beach County, where he serves as Fire Rescue Medical Director.

About the CORE network

If you suspect an overdose, call 911 immediately. The state of Florida has been deployed sources which can be placed in public areas to ensure Floridians remain vigilant for the signs of an overdose, how to respond and where help is available.

CORE has been successfully tested in Palm Beach County for nearly two years and is expanding to other counties to help patients break the deadly overdose cycle. Floridians struggling with addiction can use CORE for stabilization and drug-assisted treatment from a network of specialized medical experts who will help them on a sustainable path to healthy success.

CORE Network is a collaboration between the Florida Department of Health and the Department of Children and Families. Florida is proud of its efforts to fight the opioid epidemic and continues to do so with access, evidence-based care, and lifelong comprehensive treatment. Information about CORE and various recovery resources.

About the Florida Department of Health

Nationally accredited by the Public Health Accreditation Board, the department works to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts.

Follow us on Twitter at @HealthyFla and on Facebook. For more information about the Florida Department of Health, visit www.FloridaHealth.gov.

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