Although the opioid epidemic is getting worse, a panel of experts says it’s still possible to stem the abuse of prescription drugs and other substances while continuing to provide patients who suffer from chronic pain access to pain medications. But it will take years to undo the damage.
The National Academies of Sciences, Engineering and Medicine released a report Thursday that outlines an action plan that the Food and Drug Administration, other federal agencies, state and local governments and healthcare organizations must take in response to the opioid crisis. An 18-member committee, convened at the request of the FDA, spent more than a year studying the crisis, which every day kills an average of 90 Americans from overdoses involving an opioid.
It will take years of sustained and coordinated efforts to contain and reverse the effects of prescription and illicit opioid epidemics, which are intertwined, the committee notes. Those actions include more judicious prescribing of opioids, expanding access to treatment for opioid use disorder, preventing more overdose deaths, weighing societal impacts in opioid-related regulatory decisions and investing in research to better understand the nature of pain and develop non-addictive alternatives.
“This report provides an action plan directed particularly at the health professions and government agencies responsible for regulating them,” said committee Chairman Richard Bonnie, Harrison Foundation Professor of Law and Medicine and director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia in Charlottesville, in an announcement about the report.
The plan, he said, is to help the millions of people who suffer from chronic pain while reducing unnecessary opioid prescribing. But it won’t be easy. “We also wanted to convey a clear message about the magnitude of the challenge,” Bonnie said. “This epidemic took nearly two decades to develop, and it will take years to unravel.”
In a report released last week, the Centers for Disease Control and Prevention said that in 2015 the amount of opioids prescribed was enough for every American to be medicated around the clock for three weeks. At least two million people in the U.S. were addicted to prescription opioids in 2015. Drug overdose, driven primarily by opioids, is now the leading cause of unintentional injury deaths in the United States, and trends indicate that premature deaths associated with the use of opioids are likely to climb.
The committee makes several recommendations (PDF) to address the opioid epidemic, including:
Mandated pain-related education for healthcare professionals who provide care to people with pain: This would require healthcare professionals to receive basic training in the treatment of opioid use disorder and training for prescribers and pharmacists to recognize and counsel patients who are at risk for opioid use disorder or overdose.
Enhanced education for the public: The committee said it was struck by the relative lack of attention to educating the general public about the risks and benefits of prescription opioids. It recommends an evaluation of the impact and cost of an education program that raises awareness among patients with pain and the general public.
Universal access to evidence-based treatment for opioid use disorders in a variety of settings, including hospitals and substance-use treatment programs: Because restrictions on lawful access to prescription opioids could drive some people toward the illegal market, the committee recommends that states, with the assistance from the Substance Abuse and Mental Health Services Administration, provide treatment. In addition, the committee recommends the Department of Health and Human Services and state health financing agencies should remove impediments to full coverage of medications approved by the FDA for treatment of opioid use disorder.
Improved access to naloxone, which blocks or reverses the effects of opioids, as well as safe injection equipment to reduce transmission of HIV and hepatitis C: Providers and pharmacists must be permitted to prescribe, dispense, or distribute naloxone to laypersons, third parties and first responders. Prescribers must be immune from civil liability or criminal prosecution for prescribing, dispensing or distributing naloxone, and the government should ensure laypersons have an immunity for possessing or administering it. Furthermore, the committee said the government should permit the sale or distribution of syringes, exempting syringes from laws that prohibit the sale or distribution of drug paraphernalia, and authorize syringe exchanges.
Consideration of the public health when the FDA makes opioid-related regulatory decisions: The committee recommends that the FDA consider societal concerns during the clinical development stage as well.