Beginning in the 1990s, some drugmakers, insurers and pain specialists called for wider use of the drugs for more common ailments like backaches and arthritis. The push was tied into the marketing of drugs like OxyContin, which were billed as less addictive than other opioids.

When US overdose deaths began skyrocketing, prescription painkillers were identified as a big reason. Governments tried to restrict the prescriptions, but the overdose epidemic worsened as people hooked on pills switched to heroin and then to fentanyl. Those kinds of illegal injected drugs are now associated with the majority of US overdose deaths.

The CDC’s 2016 prescribing guidelines said opioids should not be the first treatment for chronic pain. Doctors were urged to first try other medications or nondrug options, limit opioid prescriptions for short-term pain to three days, and to prescribe the lowest effective dose possible.

The guidelines are voluntary, but they were widely adopted and added momentum to a dramatic decline in opioid painkiller prescriptions.

They also came under attack from pain patients and drug manufacturers, who argued some people in severe pain were being denied needed relief.

In 2019, CDC officials signaled that they were concerned about those reports. They examined newer research, resulting in the new proposal, Jones said. Drugmakers had no input into the writing of the draft revision, he said.