Many approaches needed to curb opioid abuse

Norwalk Hospital’s Emergency Department has reduced orders for prescription opioids by nearly half over the past two years in response to the current epidemic, a rare positive in a quagmire of negative news. Emergency Department Chairman Dr. Benjamin Greenblatt said the initiative to reduce unnecessary use of opioids succeeded beyond expectations, cutting orders by 46 percent.

He credits a “non-opiate” option on hospital computers that suggests safer alternatives for common ailments. Guest speakers and staff education on best practices for non-opiate pain management round out the program.

The goal was not to eliminate opioids but to guard against unnecessary use. That’s important, because prescription opioids serve a legitimate medical purpose in the treatment of acute and cancer pain.

We commend the hospital for seeking alternatives, something every health care provider should do. It’s a reasonable assumption that reduced use will reduce abuse. Fewer prescriptions may also shrink the population of potential abusers likely to transition to deadlier substitutes.

What it won’t do is solve the opioid problem. In fact, abuse of prescription opioids has been decreasing since 2010, when OxyContin, the drug most often implicated in initiating the epidemic, was reformulated to make it harder to crush or dissolve, thereby making it harder to abuse.

Marketed as a 12-hour extended-release pain reliever by Purdue Pharma in 1996, OxyContin was most addictive and dangerous when crushed or dissolved to deliver the entire 12-hour dose all at once.

The company paid $600 million in fines in 2007 for misleading the public about the drug’s risk of abuse. In 2010, it released the reformulated version, the first to carry the FDA’s “abuse-deterrent” designation.

After the reformulation, recreational use dropped by as much as 40 percent, and overdose deaths decreased for the first time since 1990.

They’ve since rebounded with a vengeance. In the years since 2010, there’s been a three-fold increase in drug-related deaths. Last year, Connecticut alone logged an unprecedented 1,038 fatalities, not from prescription opioids, but the street drugs that have replaced them.

Researchers at the RAND Corp. and the Wharton School have established a link between the reformulation of OxyContin and up to 80 percent of heroin deaths, an unforeseen side effect that’s proven more deadly than most prescription painkillers combined.

The FDA is pushing for more abuse-deterrent opioids. The researchers are warning that more reformulated opioids could drive more people to heroin, or heroin spiked with fentanyl, its deadlier synthetic cousin.

Disrupting the supply of prescription opioids is a step in the right direction. But it can’t be the only one. Solving one problem only to create a new, more intractable one is a game of whack-a-mole gone awry.

More attention and funding must be directed to prevention and substance abuse treatment to reduce the prevalence of addiction. Until we focus on public health strategies, we’ll keep missing the moving target.

Disrupting the supply of prescription opioids is a step in the right direction. But it can’t be the only one.