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In 2020 (the latest year for which Centers for Disease Control and Prevention (CDC) data are available), 68,630 Americans died of opioid-involved overdose—a 37.6 percent increase over 2019^*, and the largest yearly increase in opioid-involved overdose deaths in two decades.¹ A total of 16,416 (23.9 percent) of those deaths involved prescription opioids.¹ Approximately 21 to 29 percent of patients prescribed opioids for chronic pain misuse them,² and between 8 and 12 percent of patients prescribed opioids for chronic pain will develop an opioid use disorder (OUD).² It’s no surprise, then, that overdose death involving opioids is referred to as “a public health emergency”³ and an epidemic.⁴

In 2016, the CDC released a clinical practice guideline for primary care physicians prescribing opioids for chronic pain,¹ which was adopted by various entities, including Medicaid agencies and insurers.² However, according to the CDC and others, the guideline has been misinterpreted and misapplied. An example of a misapplication concern involves the management of patients with chronic pain, which are not intended to follow the same guidelines as those patients being initiated on opioids. The 2016 guidelines are in the process of being updated by the CDC. The draft guideline is available for review with an expected release in late 2022.

According to the CDC, chronic pain is a risk factor for suicidality.^1,2,3 Studies indicate several additional factors as potential predicators of increased suicide risk in chronic pain patients, including depression, anger, unemployment/disability, harmful health habits, challenging personal and family history, sleep problems, poor perceived mental health, and multiple chronic pain conditions. Newly identified psychosocial factors, including pain catastrophizing, hopelessness, and perceived burdensomeness also appear to be associated with suicidality.² On a positive note, many suicide risk factors can be addressed through an individualized chronic pain management program.²

Any patient can develop OUD and patients with OUD are at higher risk for overdose.¹ Personal history, length of therapy, and dosage play a role in the development of OUD.² A physician’s effectiveness in treating the underlying cause of a patient’s pain can be a crucial aspect of the defense in an opioid overdose case.

In the first half of 2020 — the beginning of the COVID-19 pandemic — telehealth experienced extraordinary growth as social distancing protocols, concern over spreading the virus, and other pandemic realities spurred demand and adoption. While this growth has receded since that time, usage remains well above pre-pandemic levels and the regulatory environment remains dynamic.¹