Dr. Frank Maletz, a surgeon turned advocate for change in the medical arena, likes to think of the treatment of pain as a pendulum.

Before the early 1990s, when doctors largely ignored patients’ pain, the pendulum was far to one side.

Just seven years ago, when the amount of opioids prescribed in the United States peaked, it had reached the other side.

Now, a new Centers for Disease Control and Prevention study shows, the pendulum appears to be working its way back to the middle, and Maletz isn’t surprised.

“Prescribers can get somebody hooked on these medications in 10 days,” Maletz said, “but that’s something we just didn’t know in the '90s.”

“Once new information comes out,” he continued, “we respond. This is not a surprise. Of course we’re going to write less prescriptions.”

According to the study released Thursday, opioid prescriptions were at their highest in 2010, when physicians across the nation prescribed 782 morphine milligram equivalents per capita.

That rate remained steady over the following two years before declining each year from 2012 to 2015.

While it’s not bad news, it’s bittersweet for those working to combat the opioid addiction crisis. The decline in opioid prescriptions from 2012 to 2015 was 13.1 percent. But 2015’s rate still is three times higher than it was in 1999, and four times higher than it was in Europe in 2015.

In a news release, CDC Principal Deputy Director Anne Schuchat called on health care providers to offer safer and more effective pain management.

“The amount of opioids prescribed in the U.S. is still too high,” she said, “with too many opioid prescriptions for too many days at too high a dosage.”

The rates also vary widely from county to county, the report shows.

Maps the CDC released illustrate that well. In 2015, several counties with the highest rates of prescriptions sat directly adjacent to counties with the lowest.

New London County, along with four other counties in Connecticut, landed in the second to highest category of morphine milligram equivalents per capita, which is 677 on the low end and 958 on the high. Like the other counties, its rate of prescription showed little change from 2010 to 2015.

Maletz, a member of the opioid action team New London launched in March, isn't surprised by that, either. There aren’t enough doctors in the county who specialize in pain management, he said. The result? Primary care doctors, without enough time to do elongated evaluations, prescribe more while generally using less discretion than specialists.

Indeed, a study of 2013 Medicare data published in 2015 found primary care physicians issued 28.1 million opioid prescriptions. Their nurse and physician assistant counterparts issued 7.2 million.

But modifying prescribing practices, Maletz said, is a small piece of the puzzle.

“The data is predictable and it’s just going to get better,” he said of the opioid prescription rates. “But we cannot take that data and from a societal standpoint feel good that we’ve done enough. We have to do much, much more.”

Information from a New York Times survey released Wednesday suggests drug overdoses might have jumped nearly 20 percent in 2016. If true, that would mean more than 60,000 people died from overdoses in 2016, compared to 52,400 the previous year.

Going forward, Maletz likes the idea of drug take-back drop boxes and thinks they should be more widely available, as the diversion of medications remains a problem.

He also is working toward a loftier goal of using alternative methods to create opioid-free surgeries across the state. If done right, he said, primary care physicians would be able to see whether their patients had received opioids for a recent surgery. Patients requesting refills of medications they hadn’t received in the first place could more easily be turned down.

In its study, the CDC names state-level policies as possible contributors to the decrease in prescribing. It applauds Ohio, Kentucky and Florida, for example, for requiring clinicians to review prescription drug monitoring program data. Connecticut has similar rules in place.

But legislators, Maletz said, aren’t going to quash the crisis alone. Neither are patients, insurance companies or drug makers.

He worries that too little input from doctors, nurses and physician assistants will send the pendulum beyond where it used to be — to a point where folks with horribly debilitating diseases can’t get the medications they need.

“This is a medical model,” Maletz said. “Therefore (physicians) should be the leaders of this. We should be the ones to lay out the delicate balance, to say let’s not get crazy here, but let’s take steps to make it better.”

“We need to get this fixed,” he said, “and we can do it.”

l.boyle@theday.com