Addressing abuse of prescription opioids
With 5 percent of the world’s population, the U.S. consumes 80 percent of the world’s prescription opioids. Opioids are restricted in other countries to treating acute pain associated with injuries and burns and chronic pain due to malignancies.
An estimated 12.5 million Americans misused prescription opioids in 2015. Prescription opioids accounted for at least 20,000 deaths that year; illicit opioids — heroin and counterfeit fentanyl — led to an additional 13,000 deaths.
The top five states in opioid prescriptions in 2015 were Alabama (142.9 per 100 population), Tennessee (142.0), West Virginia (137.6), Kentucky 128.4) and Oklahoma (127.8). In sharp contrast, the states with the least opioid prescriptions were Hawaii (52), California (57), New York (59.6), Minnesota (61.6) and New Jersey (62.9). Within a state, opioid use may vary widely from one county to another.
Because treatment of opioid addiction is complex, expensive and may be lifelong, prevention is key. Three-quarters of heroin addicts report that prescription opioids served as gateways to their drug dependence.
EDUCATION
Alerting children to the dangers of opioids and other drugs must begin early. The Tennessee Department of Education sets standards for
education in health that include drug and alcohol avoidance. Individual school districts design programs based on these standards that best fit their students’ needs. Atlanta-based E.F. Mendez Foundation provides a comprehensive curriculum for students from kindergarten to high school that teaches drug avoidance and violence prevention. More than 3,500 school districts and community organizations utilize the Mendez programs.
Education must extend to providers to counteract years of promotion of opioids by pharmaceutical manufacturers. Lax attitudes toward opioid prescription will take years to correct. Many state licensure boards for health-care professionals require additional study related to proper prescribing of opioids.
LEGISLATIVE ACTION
New Jersey offers an example of prevention through legislation, which was enacted in February. Assembly Bill 3 limits first-time opioid prescriptions to no more than a five-day supply. If longer-term opioids are indicated, the prescribing physician must have a written treatment plan, documentation of discussion of risks with the patient and a review of medication
usage every three months. Sixteen other states, including Arizona, Connecticut, Delaware, Massachusetts and Ohio, limit first-time prescriptions of opioids to a five- to seven-day supply. Last month, Kentucky placed a three-day limit on opioid prescriptions for acute pain.
If a single state has lax oversight of opioid prescribing, that state can become a magnet for drug seekers and drug resellers from around the region. Uniform, national regulations are the only means to limit inappropriate or criminal overprescribing of opioids.
MARKET INITIATIVES
Express Scripts, the nation’s largest pharmacy benefit manager, will limit new opioid prescriptions to a seven-day supply of short-acting drug effective Sept. 1. A pilot program based on this limit demonstrated a 40 percent reduction in emergency room visits and hospitalizations due to opioid overdose. Limits do not apply to patients with cancer or those in hospice or palliative care programs. The American Medical Association opposes the limitation, arguing that it intrudes on a physician’s prerogative to serve the unique needs of patients.
INDIVIDUAL ACTIONS
If after surgery, dental procedure or acute injury, you are given a prescription for pain, ask
for details about the medication. Is it an opioid? If so, what is the dose? Is the medication a shortor long-acting compound? Are there alternatives to the drug? If your son or daughter is on a school’s athletic team, what are the policies regarding dispensing medication for painful injuries?
PREVENTING DEATH FROM OVERDOSE
Saving lives of individuals with dangerous opioid overdose depends upon immediate availability of Naloxone. Left untreated, an overdosed person will suffer progressive depression of respiration, circulation, deepening coma and death. Naloxone blocks the action of the opioid at receptor sites within the brain and can reverse the effects of an overdose. Prompt administration by first-responders and emergency room personnel has saved thousands of lives.
Naloxone prices have soared in recent years. An injectable dose that cost less than $1 now costs from $36 to $42, depending on the supplier. An auto-injector dose of Naloxone costs more than $1,800. Runaway pricing of this essential drug limits its availability. Are price controls the answer?
The opioid epidemic has intensified for years. Sustained action at all levels of society will be needed to conquer it.