During the past two decades, the prevalence of chronic pain and healthcare costs have exploded resulting in an opioid epidemic with consequences escalating. In a journal published by Health Policy, it states that the Institute of Medicine (IOM) recently published a report showing that more than 116 million Americans had persistent pain from weeks to years, and resulted in having financial costs from $560 billion to $635 billion per year (Manchikanti, Laxmaiah, et al.). Everyday, more than 115 Americans die from opioid use which include drugs like prescription pain relievers, heroin, and synthetic opioids like fentanyl (Opioid Overdose Crisis). The misuse of opioids has caused Americans to become increasingly more addicted causing a serious national crisis that has affected public health as well as social and economic welfare (Opioid Overdose Crisis).
With opioid use increasing rapidly, scientist, doctors, Americans, and Washington is struggling on getting a handle on this crisis. In the late 1990’s pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, so health care providers began to prescribe them at a greater rate (Opioid Overdose Crisis). This eventually led to the wide spread diversion and misuse of these medications before became clear just how dangerous these drugs were and how addictive they could be (Opioid Overdose Crisis).
Opioid overdose rates began to increase. In 2015, more than 33,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid (Opioid Overdose Crisis). That same year, an estimated 2 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 591,000 suffered from a heroin use disorder (Opioid Overdose Crisis). The facts are, the opioid crisis is rising, fast, in all areas of America with drug overdose now the leading cause of accidental death in the U.S., and opioid addiction is driving this epidemic. With the crisis so clearly rising, the possibility of a solution seems hopeless.
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According to a report done by Robert M. Califf, M.D., Janet Woodcock, M.D., and Stephen Ostroff, M.D. titled, A Proactive Response to Prescription Opioid Abuse, there are multiple ways to addressing the opioid crisis. While this report gives many different ways to tackle the epidemic, there were a few that stood out that were quite shocking. Surprisingly, the first idea that this report looked at was that Califf, Woodcock, and Ostroff proposed developing better better evidence based for chronic pain treatment.
Apparently, the research done on the risks and benefits is strikingly deficient. “A key lesson learned during the development of the CDC guideline is that there is very little research on the long-term benefits of opioids for treating chronic pain, however, there is growing evidence of harms associated with such use, and of the benefits of other non-opioid treatment alternatives” (Califf, Robert M., et al.) The report continues on by saying, “given the severity of the crisis, the draft CDC guideline provides a highly reasonable set of recommendations for primary care providers to use in their clinical practices, allowing physicians and patients together to determine treatment plans on the basis of the best current understanding of risks and benefits” (Califf, Robert M., et al.).
To explore the effects of opioid use and how to lower the number of Americans becoming addicted, the report states that a clinical trial is recommended by randomly selecting participants and assigning them to continue opioid therapy or to be weaned from it on a schedule over the course of 1 year of follow-up. While this definitely something that needs to be looked at, there are other things that need to be addressed in order to resolve the opioid crisis in anyway.The next suggestion that should be considered is refining guidelines for when opioid use is appropriate.
The doctors and nurses who are prescribing the medication need adequate knowledge on the drugs they are supplying to the American people. The report states in order to do this, we much engage the clinical community in a concerted approach to curbing inappropriate prescribing and proactively treating opioid addiction, while reinforcing evidence-based approaches to treating pain in a manner that spares the use of opioids (Califf, Robert M., et al.). Until clinicians stop prescribing opioids far in excess of clinical need, this crisis will continue unabated (Califf, Robert M., et al.).
The final suggestion that needs to be taken into consideration is deterring abuse and mitigating harm from overdose. This, in other words, means that the FDA and pharmaceutical industry is looking for ways to discourage people from using opioids while also trying to find a way to make opioids less harmful and addictive. The FDA has strongly supported the development and assessment of abuse-deterrent formulations of opioids, five of which the agency has already approved (Califf, Robert M., et al.). The pharmaceutical industry has shown significant interest in developing abuse-deterrent opioid formulations and the field is progressing rapidly (Califf, Robert M., et al.). The FDA is also strongly supporting the development and marketing of countermeasures that can reverse overdose, such as the opioid antagonist naloxone (Califf, Robert M., et al.).
Rapid advances in the development and distribution of injectable and intranasal naloxone offer an example of an effort in which broad intersectoral collaboration has saved substantial numbers of people who would otherwise have died from overdose (Califf, Robert M., et al.). To further advance changes, involvement from capitol hill to pass bills, fund trials, and promote more research into the opioid epidemic needs to be considered.Extreme partisanship is rampant, but there is hope for cooperation from both Democrats and Republicans to stop the abuse of opioids (Howell Jr., Tom).
This an issue where all sides have said they want to act, though getting agreement on anything hasn’t always been smooth (Howell Jr., Tom). Both parties are known to disagree which has frustrated many Americans, but this crisis is something both sides have agreed that something needs to happen. Senator Rob Portman, an Ohio Republican who has taken the lead on the issue, was only able to get five fellow Republicans last year to sign onto his bill to root out synthetic opioids pouring into the U.S. through postal packages from China (Howell Jr., Tom). This year, he’s already gotten several Democrats to join him (Howell Jr., Tom). Other co-sponsors from either party include Sen.
David Perdue, a Georgia Republican who is staunchly pro-life and anti-gun control, and Sen. Elizabeth Warren, a Massachusetts Democrat and hero to the progressive left who highlights the political breadth of the problem and eagerness to deal with it (Howell Jr., Tom). Furthermore, another bill, the Stop OD Act of 2017, would authorize grants to highlight the dangers of opioids and expand the use of overdose-reversing drugs which has more than 20 House co-sponsors, scattered from Hawaii to New Hampshire, and roughly split between Republicans and Democrats (Howell Jr., Tom).
As well as dozens of organizations representing physicians, pharmacies, insurance companies and other special interest groups have participated in different actions to further the research on opioids. The CDC has provided a list to Pain News Network of over 50 organizations that were sent invitations to the webinar – the first and only time the CDC publicly disclosed its prescribing guidelines and sought public input (Special Interest Groups Behind CDC Opioid Guidelines). Many Americans believe opioid addiction is a problem with two-thirds of respondents in a national Kaiser Family Foundation (KFF) poll agree that prescription drug abuse is a very serious problem, while 44 percent say they personally know someone who has struggled with addiction (Johnston).
Overall, despite widespread concern with opioids, the public doesn’t seem to feel that more federal dollars are what will make the difference, so it is not surprising that Congress has been reluctant to fund treatment programs. Although this is believed, Congress needs to consider taking action in fighting this epidemic by talking more about ways to halt the increase of abuse on opioids, continue to put the epidemic in the media, and most importantly, adequately research the benefits and risks of opioid use. I recommend this problem gets help from the government in order to fully combat this epidemic.
Prescribing medications without proper knowledge of its effects is detrimental to the American public. More research needs to be considered to deter abuse and mitigate harm from overdose. We need to make sure our clinicians know exactly what they are giving our fellow Americans, and the government needs to implement other ways to further combat the opioid abuse. Without help from the federal level, I fear Americans will not be able to defeat this epidemic that is increasing rapidly.
