Opioid labels are a step, but not enough to overcome overdose
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An image of a four-year-old in the backseat of a car with two adults overdosed in the front has recaptured the imagination of the American public. Since the death of Prince, this image has once again redefined the opioid epidemic for so many, showcasing the breadth of substance abuse disorder in this country.  

The opioid epidemic is evolving rapidly, and it seems our regulators and lawmakers are always a step behind. The recent ruling by the U.S. Food and Drug Administration (FDA) to require stronger warning labels for opioid painkillers, particularly when combining them with benzodiazepines like cough medicine, is a positive for curbing future misuse of opioids, but it does not address those already afflicted by the disease of addiction.

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Opioid abuse and overdose in this country is at an all-time high. According to the Centers for Disease Control & Prevention, almost 80 Americans die every day from an opioid overdose and this number is not expected to slow down – even with new black box warnings. This equates to 28,000 Americans dying annually, which is more than traffic accidents or the second leading cause of accidental deaths.

The reality is that prevention of future overdoses requires a different, more immediate action to be taken: Ensure doctors who are prescribing opioids provide naloxone, the opioid overdose reversal antidote, as a coinciding prescription or “co-prescribing” it. The recent endorsement of co-prescribing by the American Medical Association, as well as its inclusion in the Comprehensive Addiction Recovery Act, have laid out a tremendous opportunity for regulators to decisively tackle the rapid increase in opioid overdoses.

By encouraging or even mandating the co-prescription of naloxone with opioids, particularly those patients who are more likely susceptible to an overdose due to dosage or drug interactions, we can double down on creating conversation between doctors and patients regarding the inherent risk of using an opioid, distributing more naloxone in areas hardest hit by the epidemic, and reducing the stigma associated with substance abuse disorder.

If we were to co-prescribe naloxone in conjunction with these new black box warnings on opioid painkillers, we could provide the first one-two punch that can actually begin making an immediate impact in slowing down this growing public health crisis. More importantly, something beyond a doctor’s control, it is critical for Congress to continue to play a role in funding and expanding our efforts to curb the opioid overdose epidemic by taking a page from the Department of Health & Human Services (HHS).

HHS recently announced a $53 million award to address the opioid epidemic, specifically the inclusion of funds towards the increased access to naloxone in communities. It is a major concern that more potent, synthetic opioids like fentanyl and carfentanil are being laced in the current heroin and painkiller supply, which are causing severe strings of opioid-related overdose in towns and cities across the country.

Both the CDC and the Drug Enforcement Agency have warned the general public and even our law enforcement officers that exposure to these opioids is extremely dangerous and require stronger naloxone doses in shorter windows of time to reverse overdose effects. Consequently, it is critical that doctors not only offer stronger doses of naloxone when co-prescribing but also have Congress guarantee EMS and police officers are equipped with the emergency response protocols that include high-dose naloxone formulations intended for community-use.

As the problem of opioid abuse and overdose evolves, so must our response. Otherwise, we are putting lives at risk for unnecessary injuries or death.

It is evident that opioid overdoses are affecting all Americans, no matter their race or socioeconomic status, and family, friends, and caregivers are becoming the first responders in overdose emergency situations. By providing these folks and their loved ones who are susceptible to an overdose the tool they need to reverse a potential death is critical, especially when there are formulations of naloxone out there that are FDA-approved and ready-to-use for laypeople in community settings.

Progress requires action, or else society will continue to be shocked by this disease.

Dr. William Morrone is a board certified pain physician that specializes in the treatment of chronic pain and addiction and is Bay County's deputy chief medical examiner and chief medical officer for Recovery Pathways in Bay City and Ortonville, Michigan. Dr. Morrone trained at the Armed Forces Institute of Pathology (AFIP) and has been a medical guest on CNN, HLN, and FOX News.


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