Federal government must act now to reverse the opioid addiction epidemic

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The United States is in the midst of the worst drug addiction epidemic in its history. There are big increases in illicit opioid use. Heroin as well as illegally produced fentanyl and other synthetic products are driving this still-growing epidemic. However, about half of the people who died from an opioid overdose were killed by a prescribed medication.

There is no simple solution to ending this epidemic. Two months ago, the White House instructed the administration to use all possible emergency measures to respond to the epidemic.

In this week’s issue of the Journal of the American Medical Association, my colleague and I write about action in battling the opioid epidemic. This includes emergency regulations or other emergency responses — at federal and state levels.

Here are 10 specific areas that could greatly accelerate progress in preventing addiction, overdose, and death.

1. Improve tracking of new opioid addiction

No current information systems allow real-time assessment of the epidemic; we don’t know if more or fewer people are getting addicted now than before. Prescription Drug Monitoring Programs (PDMP) and other data systems could help identify trends, allowing us to address the current drivers of addiction.

2. Improve quality of medical examiner and coroner work

Real-time data on overdoses can enable rapid response to changing patterns of opioid use. More complete and rapid testing, and more information on specific drugs involved in overdose deaths, including access to data from PDMPs by coroners and medical examiners, would lead to more effective interventions.

3. Promote more cautious prescribing for acute pain

Opioids are essential medicines to treat severe pain after surgery or serious injury, but too often are prescribed for pain that could be treated with other medications, such as dental surgery. When opioid use is unavoidable, dosage should be as low and duration as brief as possible, as dependence can develop in as little as one week. Prescriptions for more than 3 days of medication for acute pain are dangerous and should be rare.

4. Restrict or eliminate marketing of opioids for chronic pain

The risks of opioids are likely greater than the benefits for common chronic conditions (e.g., low back pain, fibromyalgia). However, patients with these conditions have been the target for opioid marketing. The US Food and Drug Administration (FDA) should halt marketing of opioids for situations where risks of use outweigh potential benefits.

5. Increase insurance coverage for non-opioid pain management

Chronic pain is a serious and potentially disabling problem for millions of people. Opioids are likely less effective and certainly more dangerous than other methods of pain management. Full reimbursement for non-prescription analgesics, such as acetaminophen or NSAIDs, would remove financial disincentives for patients. Easier access to and low or no copayments for physical therapy and other non-drug pain management could reduce medication use and improve patient outcomes.

6. Interrupt the supply of illicit opioids

As with tobacco and alcohol, if heroin and illicitly produced synthetic opioids such as fentanyl are more expensive and more difficult to obtain, use is likely to decrease. In addition, the legal system can implement programs such as treatment as an alternative to incarceration, and correctional facilities can provide treatment for addicted inmates and linkage to treatment services upon release.

7. Identify possible opioid addiction early

Early identification and treatment of opioid addiction can reduce the risk of overdose, injection drug use, and medical complications. States should mandate prescriber checking of and timely data to PDMPs, and state health officials should identify patterns of use that may indicate opioid-addiction (excess prescriptions filled, increasing dosages) as early as possible and facilitate referral to treatment.

8. Expand access to treatment

Many patients who would benefit from buprenorphine or methadone treatment will receive it only if it becomes more attractive and accessible than either prescription or illicit opioids. In France, opioid overdose deaths decreased 79 percent six years after widespread prescribing of buprenorphine. Access to buprenorphine could be expanded if the federal government removes regulatory barriers and incentivize or require health systems to offer buprenorphine treatment. It’s cruelly ironic that the only opioid that may be less addictive than heroin — buprenorphine — has the most barriers to prescription.

9. Implement harm reduction for current users

Access to clean syringes — as Governor Mike Pence approved in Indiana, resulting in a rapid reduction of spread of HIV — can prevent injection-related infectious diseases, and access to naloxone can reduce fatal overdoses. The federal government should continue to assist state and county efforts to make naloxone and clean syringes more widely available, and the FDA should accelerate efforts to approve an over-the-counter naloxone product.

10. Consider removing ultra-high dosage opioids from the market

Commonly used formulations of opioids are dangerous and should be removed from the market. For example, a patient who takes one oxycodone 80 milligram tablet twice a day is consuming a dosage associated with a greatly increased risk of death. Because only one pill is taken at a time, people may not appreciate that this is an extremely high dose, and a single pill diverted from a prescription supply could result in a fatal overdose.

The opioid addiction epidemic has worsened over the course of a generation and will not end overnight. Governments at all levels must approach it as the national emergency it is and support rapid implementation of actions that will prevent people from becoming addicted, help people who are addicted, and save lives.

Tom Frieden, MD, MPH, is former Director of the Centers for Disease Control and Prevention and currently President and CEO of Resolve, an initiative of Vital Strategies.

Tags Mike Pence Opioid abuse

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