Na­tion & World

Pre­scrip­tion painkillers, heroin fuel the worst ad­dic­tion cri­sis in U.S. his­tory Re­port: FDA should con­sider real-world im­pact on pa­tients, fam­i­lies, crime

The Denver Post - - FRONT PAGE - By Carla K. John­son

A re­port calls for a study of the im­pacts painkillers have on pa­tients, fam­i­lies, crime and the de­mand for heroin. »

The Food and Drug Ad­min­is­tra­tion should re­view the safety and ef­fec­tive­ness of all opi­oids and con­sider the real-world im­pacts the painkillers have, not only on pa­tients but on fam­i­lies, crime and the de­mand for heroin. That’s the con­clu­sion of a re­port from the Na­tional Acad­e­mies of Sci­ences, Engi­neer­ing and Medicine.

It urges the FDA to bol­ster a pub­lic health ap­proach that al­ready has resulted in one painkiller be­ing pulled from the mar­ket. Last week, the maker of opi­oid painkiller Opana ER with­drew its drug at the FDA’s re­quest fol­low­ing a 2015 out­break of HIV and hep­ati­tis C in south­ern In­di­ana linked to shar­ing nee­dles to in­ject the pills.

“Our rec­om­men­da­tion is for a much more sys­tem­atic ap­proach, in­te­grat­ing pub­lic health de­ci­sion-mak­ing into all as­pects of opi­oid re­view and ap­proval,” said Dr. Aaron Kes­sel­heim of Har­vard Med­i­cal School, a mem­ber of the re­port com­mit­tee.

The re­port de­tails how two in­ter­twin­ing epi­demics — pre­scrip­tion painkillers and heroin — led to the worst ad­dic­tion cri­sis in U.S. his­tory and pro­vides a plan for turn­ing back the tide of over­dose deaths.

Pre­scribed, le­gal drugs are a gate­way to il­licit drugs for some, the re­port says. Other users start with pills di­verted to the black mar­ket. Crush-re­sis­tant pills and other re­stric­tions can have un­in­tended con­se­quences, shift­ing use to heroin and il­licit fen­tanyl.

The epi­demic’s broad reach into ru­ral and sub­ur­ban Amer­ica “has blurred the for­merly dis­tinct so­cial bound­ary be­tween use of pre­scribed opi­oids and use of heroin and other il­le­gally man­u­fac­tured ones,” the re­port says.

The au­thors say it’s pos­si­ble to stem the cri­sis with­out deny­ing opi­oids to pa­tients whose doc­tors pre­scribe them re­spon­si­bly. But long-term use of opi­oids by peo­ple with chronic pain should be dis­cour­aged be­cause it in­creases dan­gers of over­dose and ad­dic­tion.

John Moore, Getty Im­ages

A 27-year-old who said he is ad­dicted to pre­scrip­tion med­i­ca­tion lies passed out in a pub­lic li­brary in 2016 in New Lon­don, Conn. A re­port re­leased Thurs­day calls for bet­ter ac­cess to treat­ment for opi­oid ad­dic­tion in hos­pi­tals, prisons and treat­ment pro­grams in ad­di­tion to year-round pro­grams that al­low peo­ple to re­turn unused opi­oids to any phar­macy at any time.

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