What is the Government Doing to Combat the Opioid Abuse Epidemic?Anna Ciulla
At the center of today’s drug abuse epidemic and the U.S. government’s effort to combat it, is a group of highly addictive drugs known as opioids, which includes heroin and other prescription painkillers, like oxycodone, hydrocodone, codeine, morphine, fentanyl and others. They get their name from their association with the body’s chemically related opioid receptors: opioid drugs act on these nerve cells in the brain and throughout the nervous system to relieve pain and produce a euphoric high. This article will educate readers on today’s opioid abuse epidemic and what the U.S. government is doing to address the public health crisis.
Stats on Opioid Addiction
Today, both the abuse and distribution of opioids are at epidemic proportions:
- Drug overdose is the leading cause of accidental death in this country, having now surpassed car accidents as the most common cause of death.
- More Americans reportedly died from drug overdoses in 2014 than in any previous year, and roughly three out of four of these deaths occurred because of an opioid.
- Since 1999, both overdose deaths involving opioids and sales of opioids nearly quadrupled, while treatment admissions for opioid use disorders increased six fold, according to a 2016 fact sheet published by the American Society of Addiction Medicine (ASAM).
- 78 Americans die every day from an opioid overdose, according to a report by the Centers for Disease Control (CDC), with prescription opioid drugs accounting for the great majority of these casualties.
U.S. Government’s Response to Opioid Abuse
In recent years, mounting public alarm about these high rates of opioid abuse and related fatalities has prompted the U.S. government to take action. The result has been fresh bipartisan legislation and more aggressive, urgent and coordinated efforts by the White House, U.S. Congress and various U.S. government agencies to address the crisis.
A statement in September 2013 by the former director of National Drug Control Policy, Gil Kerlikowske, conveys the urgency of these efforts to resolve America’s national opioid problem: “Heroin use and prescription drug abuse can have deadly consequences … while heroin use is still far less common than prescription drug abuse, we will continue to ensure that agencies across the Federal Government in close coordination with state and local authorities continue to respond quickly and effectively to this significant threat.” (In 2009, Kerlikowske reportedly declared an end to use of the term, “war on drugs,” and went on to advocate for a more comprehensive policy that includes prevention, treatment and enforcement.)
Kerlikowske’s successor, Michael Botticelli, a recovering alcoholic, has toed a similar policy line. In a statement before Congress in April 2014, he said a national policy response to heroin and other opioid drugs should be “guided by what experience, compassion, and science demonstrate about the true nature of drug use in America.”
Thus far, the U.S. government appears to be responding accordingly. Or so a plan unveiled in 2015 by the Department of Health and Human Services (HHS) would seem to suggest. The plan targets three defining areas of focus, detailed in the sections below:
- improving prescribing protocol for opioids
- expanding the availability of the overdose prevention drug naloxone to curb opioid-related overdose deaths
- expanding access to Medication-Assisted Treatment (MAT), including prescriptions to medications such as Suboxone, which treat opioid addiction
New Guidelines for Prescribing Opioids
In March 2016, as part of a government effort to improve prescribing protocol involving opioids, the CDC issued national guidelines to primary care providers for treating chronic pain not associated with active cancer treatment or palliative and/or end-of-life care. The guidelines make recommendations that cover:
- when to initiate or continue opioids for chronic pain
- opioid selection, dosage, duration, follow-up and discontinuation
- how to assess patients’ risks of opioid use
- how to recognize the harmful effects of opioid abuse in patients
In its recommendations to doctors for assessing whether the benefits of prescribing painkillers outweigh the risks, the CDC relied on clinical guidelines developed from a multidisciplinary panel’s research. The CDC also provides an opioid prescription checklist and a website with additional resources to guide clinicians in implementing its recommendations.
Expanding Access to Naloxone to Prevent Overdose Deaths
Expanding access to the life-saving drug naloxone, which for over three decades has helped emergency medical personnel reverse overdoses, is another linchpin of the U.S. government’s response to the opioid epidemic. On the basis of research showing that expanded access to naloxone can effectively reduce opioid-related fatalities, a majority of U.S. states have Naloxone Access Laws and/or 911 Good Samaritan Laws on their books. Such laws are intended to increase emergency care and treatment for opioid overdoses, by making naloxone more readily available to first responders, who may be fearful to administer naloxone in emergencies.
Naloxone Access Laws clarify that those acting in good faith may prescribe naloxone to persons who may be able reverse an overdose, without fear of legal reprisal. Good Samaritan Laws encourage bystanders to summon emergency responders without fear of arrest or other legal reprisal. As a federal law, the Comprehensive Addiction and Recovery Act (CARA) effectively broadens the reach and impact of these already-existing state laws.
Expanding Access to MAT
The U.S. government is also expanding access to MAT for opioid use disorders. In the spring of 2016, the Substance Abuse and Mental Health Services Administration (SAMHSA) launched a new program to “provide funding to states to enhance/expand their treatment service systems to increase capacity and provide accessible, effective, comprehensive, coordinated care, and evidence-based medication-assisted treatment (MAT) and recovery support services to individuals with opioid use disorders seeking or receiving MAT.”
Similarly, expanded access to MAT for opioid disorders was the stated rationale for the $94 million in Affordable Care Act funding that HHS recently disbursed to 271 health centers in 45 states, the District of Columbia and Puerto Rico.
In a press release announcing the award, HHS Secretary Sylvia Burwell called the opioid epidemic “one of the most pressing public health issues in the United States today.” She added:
“Expanding access to medication-assisted treatment and integrating these services in health centers bolsters nationwide efforts to curb opioid misuse and abuse, supports approximately 124,000 new patients accessing substance use treatment for recovery and helps save lives.”
These three key elements of the government’s response to the opioid epidemic —new prescribing guidelines, expanded access to naloxone, and expanded MAT —are also apparent in the provisions of a newly passed, federal law known as the Comprehensive Addiction and Recovery Act, or CARA. Some of CARA’s other provisions, highlighted by ASAM, include:
- expanded access to a federally mandated, electronic prescription drug monitoring program
- funding of new pilot programs for the non-residential treatment of pregnant and postpartum women
- expanded training of medical providers in pain management and opioid prescribing
- new training and education recommendations for opioid prescribers