Comprehensive Program Needed to Solve the Opioid Crisis – By Thomas Price, MD (realclearpolitics.com) / Sept 14 2018
According to the Center for Disease Control, there were over 72,000 overdose deaths last year — the majority from opioids. These numbers are staggering. President Trump’s executive order to address this crisis was applauded from all corners. Now, months since that order, there is a growing sense of need for more concrete action. With deaths increasing year after year, this is a national scourge begging for attention and action.
This crisis knows no bounds. It is an equal opportunity offender, affecting all demographic and socio-economic groups. The stories are heart-wrenching: babies born already addicted — suffering from neonatal abstinence syndrome; opioid orphans whose parents have tragically died at the hands of this disease; parents notified of the death of their child, in spite of the fact that their loved one had previously been treated for multiple overdoses without any parental notification; jobs lost to addiction, families devastated, communities torn apart and struggling to contend with the epidemic.
This is a multi-factor issue. The drugs are cheaper and more potent, with illicit drugs often hundreds of times more powerful than prescription medication. The federal governments’ Pain as the Fifth Vital Sign program, launched in the 1990s, seemingly incentivized physicians to prescribe more and more narcotics. There are currently states that have more outstanding opioid prescriptions with available refills than the number of people living in their state.
Some pharmaceutical manufacturers downplayed the risks of opioid addiction with prescription medication. Estimates are that 80 percent of those addicted had their first exposure to opioids with the filling of a legitimate prescription.
Government has been slow to respond and has lacked both real-time information and resolve. That must change. At the Department of Health and Human Services there is a greater focus on solutions. Last year, they had proposed a five-part comprehensive strategy that could play a significant role in getting us back on track:
- Ensure that prevention, treatment and recovery programs are robust and omnipresent. We know what works well, with medication-assisted-treatment (MAT) tried and true.
- Be certain overdose reversing drugs are available whenever and wherever needed. Naloxone and Narcan are life-savers and must be in the hands of those on the front lines.
- There is much public-health work needed: Why is it that there are so many helpless and hopeless people in our society driven to addiction? The answer to this question will guide us in the right direction.
- Innovation is key. Science can offer new non-addictive pain medicines. There has been exciting progress on this front and we must continue to encourage its advance.
- Pain-management must be revised. How do we treat pain? Is an opioid actually necessary in most instances? Are there non-conventional treatments available? This is an area of medicine that needs greater attention.
In addition, there must be more focus on the supply-side of this crisis. The administration has brought new life to this issue as well even though we still seem stuck and the tragedies continue to mount.
The good news is that we have addressed major health crises before with real success. Smallpox is no more. Polio is close to eradication. The Ebola crisis was aggressively acted upon and remarkably shortened in its consequence. HIV/AIDS, once a death sentence, is now essentially treated as a chronic disease with many patients leading relatively normal lives. One of the reasons for the success in this last example was the resolve of the federal government. A coherent program and strategy followed a presidential directive, PEPFAR, the Presidential Emergency Program for AIDS Relief.
This should provide a template for a new directive with similar effort and commitment, something first brought to my attention by Dr. Francis Collins at the National Institute of Health. This directive could be called PEPFOAR, Presidential Emergency Program for Opioid Abuse Reduction.
The Public Health Emergency already declared is time-limited (it must be renewed every 90 days) and comes with few, if any, resources attached. With new resources of $6 billion included in the past budget agreement, and the prospect of additional resources being made available, this is an ideal time for structure to be put in place to accomplish real change. PEPFOAR could also include an inter-agency directive necessary to fuel an aggressive response and to garner congressional support and appropriation so that the needed resources, structure, and oversight are put in place.
President Trump has rightly articulated a vision of our generation being the one “that ends the opioid epidemic.” A specific presidentially directed emergency program with unquestioned charge, focus, and support would ensure that vision is met.
