Ex-CDC chief: Ban ‘ul­tra-high-dosage’ painkillers

Ar­ti­cle’s au­thors urge mul­ti­fac­eted ap­proach to tack­ling opi­oid cri­sis

The Washington Post - - NEWS - BY LENNY BERN­STEIN More at wash­ing­ton­post.com/ news/ to-your-health

The Food and Drug Ad­min­is­tra­tion should con­sider ban­ning “ul­tra-high-dosage” painkillers from the mar­ket and law en­force­ment must step up ef­forts to curb the flow of heroin and fen­tanyl into the United States if the na­tion hopes to come to grips with the opi­oid epi­demic, two au­thor­i­ties on the cri­sis said Thurs­day.

An­drew Kolodny, co-di­rec­tor of opi­oid pol­icy re­search at the Heller School for So­cial Pol­icy and Man­age­ment at Bran­deis Univer­sity, and Thomas R. Frieden, for­mer di­rec­tor of the Cen­ters for Dis­ease Con­trol and Preven­tion, said a com­pre­hen­sive ap­proach to the cri­sis also should in­clude greatly re­strict­ing or elim­i­nat­ing the mar­ket­ing of opi­oids for chronic pain; bet­ter in­sur­ance cov­er­age and ac­cess to al­ter­na­tive pain treat­ments; and ex­pan­sion of treat­ment and “harm re­duc­tion” mea­sures such as nee­dle ex­change pro­grams.

“There are no sim­ple so­lu­tions to end­ing this epi­demic,” Kolodny and Frieden wrote in an opin­ion ar­ti­cle re­leased Thurs­day in JAMA, the jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion. “Ef­fec­tive pro­grams need to ad­dress two sep­a­rate pri­or­i­ties: preven­tion of ad­dic­tion among peo­ple not cur­rently ad­dicted, and treat­ment and risk re­duc­tion to pre­vent over­dose and death among the mil­lions of in­di­vid­u­als in the United States now ad­dicted.”

About 33,000 peo­ple died of over­doses to pre­scrip­tion nar­cotics, heroin or fen­tanyl in 2015, a to­tal thought to have in­creased sharply in 2016, although fi­nal data is not avail­able. About 92 mil­lion peo­ple were pre­scribed an opi­oid anal­gesic — such as oxy­codone or hy­drocodone — in 2015.

Many of the rec­om­men­da­tions from Kolodny and Frieden re­flect ex­pert con­sen­sus, in­clud­ing their push for ex­panded treat­ment and wider avail­abil­ity of the over­dose an­ti­dote nalox­one and for doc­tors to use more cau­tion pre­scrib­ing opi­oids. But other rec­om­men­da­tions, such as ban­ning high-dose opi­oids and im­prov­ing the gath­er­ing of data on the ad­dic­tion cri­sis, have been heard less of­ten.

In an in­ter­view, Frieden said a small num­ber of peo­ple may need an 80-mil­ligram oxy­codone pill for the pain of cancer or end-of-life ill­ness. But that dose, taken twice a day, far ex­ceeds an amount “as­so­ci­ated with a greatly in­creased risk of death,” he and Kolodny noted in their ar­ti­cle. An un­wary user who takes a sin­gle pill con­tain­ing that much oxy­codone to get high risks a fa­tal over­dose.

“Th­ese are dan­ger­ous drugs. They kill peo­ple,” said Frieden, a mem­ber of the jour­nal's editorial board. “And we should use them very spar­ingly and care­fully.”

Pres­i­dent Trump said in Au­gust that he would de­clare the cri­sis a na­tional emer­gency, but his ad­min­is­tra­tion has not for­mally done so.


Ex-CDC di­rec­tor Thomas R. Frieden said the 80-mil­ligram ver­sion of oxy­codone, above in 10-mil­ligram form, poses se­ri­ous risks.

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