We as Americans are addicted, and it’s killing us. There are an estimated 20.8 million people in this country living with substance use disorder, and a good portion of those are living with opioid addiction. According to the landmark 2016 Surgeon General’s report, 12.5 million Americans reported misusing prescription pain relievers, and more than 300,000 reported using heroin in the previous year.
Last week, the President's Commission on Combating Drug Addiction and the Opioid Crisis met in D.C. to discuss and explore innovations in pain management, addiction treatments, overdose prevention measures and emergency medications.
We owe it to our fellow citizens to develop a comprehensive and collaborative approach to preventing, addressing, and treating those that are now or may become addicted to any range of substances.
Ensure the government is involved
We need support from the top down and back up again. There are currently a number of barriers to solving and preventing crises such as the opioid epidemic, ranging from prescribing practices to the criminalization of drug use. Despite a greater dialogue and sweeping demand, there are systemic barriers to developing, distributing and ensuring access to new medications and medical devices.
Whether it is the opioid epidemic, alcohol abuse or smoking, we need to identify immediate as well as long-term solutions. This includes expedited approval pathways, reimbursement and public-private partnerships — so that innovation, adoption, support and use can avoid political deadlocks.
We already see progress in establishing and involving policymakers and government leaders in confronting the opioid epidemic. Both the Office of National Drug Control Policy and the President’s Commission on Combating Drug Addiction and the Opioid Crisis are case studies of how government can champion and potentially streamline drug development so that patients can begin benefitting sooner.
We are fortunate to have found the collaborative partners that we have, from our work on intranasal naloxone with NIDA, to our more recent heroin vaccine collaboration with both NIDA and the Walter Reed Army Institute of Research.
Invest in research and innovation that brings the best minds together
We need to challenge our most creative investigators and incentivize their leadership to develop therapeutic strategies that can address addiction — from warning signs and general prevention to life-saving, emergency response medications. Of the previously mentioned 21 million people with a substance use disorder, only 2.2 million individuals (10.4 percent) received any type of treatment, according to the 2016 Surgeon General’s report.
This disparity is due, in part, to the reticence of the pharmaceutical sector to invest in novel medications to treat substance use disorders, as well as the time consuming and cumbersome drug development and approval process.
We need to look at novel solutions, but the immediate need requires that we get creative with the proven medications we have on hand. An example of this is the creation of intranasal naloxone, now commonly referred to as “NARCAN Nasal Spray,” which was born out of the need to provide our communities with an intuitive, ready-to-use, reliable opioid overdose reversal medication.
Through a collaboration with the National Institute on Drug Abuse (NIDA), we championed a reinvention of a trusted medication in a dose and delivery mechanism that patients and their loved ones could adopt with minimal or no training.
We must build on these lessons and look to engage all facets of the healthcare delivery system, including payers, providers and patients, to better implement a similar success for those suffering from alcohol use disorder.
Intranasal naloxone unlocked a patient population previously helpless until emergency responders arrived on the scene, and we need top researchers to come together, like Opiant has done with NIDA, to explore how to tap into similar real-world-inspired, innovations to rapidly address the needs of patients with substance use disorders.
Reform training guidelines and mandated curricula
From physicians and PAs to nurses and pharmacists, leaders in medical education need to train our future healthcare providers on safe prescribing practices, how to communicate the risks of opioid use with their patients and treat addiction as a medical condition like diabetes, and not a moral failing.
These medical experts can act as a gateway to more comprehensive treatment. Reforming training and continuing education of those already in the medical field will help them to:
1) Identify potentially at-risk patients
2) Consider a range of pain management therapies to avoid defaulting to opioids
3) Contribute to an open dialogue about addiction, ultimately curbing its stigmatization
As a physician, I spent the first part of my career observing the blatant personal and medical marginalization of patients suffering from addiction. Whether it is an emergency response to an overdose or a surgical procedure to ease the pressure of an infected injection site, the treatment approach of these substance use disorder symptoms are all too often intertwined with an air of blame.
Reforming training and mandating continuing medical education on the topic of addiction will inherently begin to reframe addiction as a disease, ultimately destigmatizing addiction, creating a dialogue among provider and patient, and allowing for more effective treatment.
The truth is, hundreds of people die each day due to substance use disorder, and among them are an estimated 91 daily overdoses related to opioids.
We do not have time to waste, we must ensure access to the medications and therapies we have now that can help save lives or improve rehabilitation.
Also, we don't have the luxury of waiting for new molecules to be explored, investigated and evaluated in the traditional drug development process.
The above strategies will impact the opioid crisis we are facing, but they will also prevent us from ending up in a similar catastrophe in the future. Through education, research and public-private collaboration, we can and will prevent losing more lives to the opioid epidemic.
Dr. Roger Crystal is the CEO of Opiant Pharmaceuticals, which is a specialty pharmaceutical company dedicated to developing medications for addiction. Crystal led the development of the first and only FDA-approved intranasal naloxone, NARCAN® Nasal Spray, the emergency treatment for opioid-overdose.