A solution is in sight for U.S. opioid epidemic

While chronic opioid therapy is controversial, most pain specialists agree that there is a role for these strong medicines in the treatment of severe, chronic pain that has failed more conservative treatment. Indeed, there are many patients who are only able to have a meaningful quality of life because of them. However, in spite of careful prescribing and patient education, there are substantial risks associated with opioid medications, such as hydrocodone, oxycodone, morphine, codeine and related drugs.

These risks range from simple side effects to more serious risks such as dependence or addiction, and finally, include the most serious — respiratory depression and death. In Texas alone, there are more than 500 deaths each year related to opioids. On average, 44 Americans die every day from prescription opioid overdose. In fact, drug poisoning, driven largely by prescription opioid pain medications, has now surpassed automobile collisions as the leading cause of accidental death in the United States.

In June, Gov. Greg Abbott signed SB 1462, authored by Sen. Royce West, D-Dallas, and Rep. Eric Johnson, D-Dallas, into law. The purpose is to increase Texans’ access to naloxone — a drug that can help reverse an opioid overdose — and has been used in emergency and hospital settings for more than 40 years, helping to save thousands of lives. The drug helps restore breathing when administered to a patient suffering from a life-threatening opioid emergency. Thanks to the Texas Legislature and Abbott, doctors now will be able to make naloxone a regular part of the treatment plan for patients who rely on powerful prescription opioids for pain control.

The number of opioid overdoses that occurs among patients who are not intentionally misusing their medications is staggering. There are two potential ways to address this problem head-on:

• Dialogue: We need to initiate open conversations to educate prescribing clinicians, our patients and communities about the risks of opioids, including accidental overdose.

• Co-prescriptions: Patients who are at risk for an opioid emergency — either because of concomitant medical conditions, the strength of the prescribed opioid or other health factors — should be co-prescribed naloxone along with their opioid prescription.

It’s a physician’s responsibility to explain the risks associated with prescription opioids and make sure patients have the tools they need to safely take their medications. Patients should understand the importance of taking medicines precisely as directed, be aware of contraindications (such as consuming alcohol with their medications) and should know how to respond should a complication occur (seek help and administer naloxone if the patient is experiencing respiratory depression).

SB 1462 is a great start, and last month’s FDA public meeting exploring the uptake and use of naloxone to reduce the incidence of opioid overdose fatalities was another important milestone to building momentum around a co-prescription model. In addition to being potentially life-saving, standardizing a co-prescription program would also destigmatize discussions around overdose and make them a natural part of physician-patient interaction.

Just last year, the FDA approved a naloxone autoinjector, the only take-home naloxone specifically labeled for the emergency treatment of known or suspected opioid overdose by family members or caregivers in settings where opioids may be present, such as the home. This option for naloxone could be critical in combatting the opioid overdose epidemic. Consider this: Opioid overdoses can cause a patient’s breathing to slow down or even stop, and lack of oxygen can lead to brain injury in as little as four minutes, while the average response time for EMS is 9.4 minutes.

Many professional organizations and government agencies argree that naloxone co-prescriptions could ultimately have a positive impact on this important safety issue. The American Medical Association, Veterans Health Administration and the American Society of Addiction Medicine have publicly endorsed co-prescription of naloxone for at-risk patients.

As we move forward, I am hopeful that policymakers in Texas and at the federal level will follow suit and make the co-prescription of naloxone the standard of care. As clinicians, we need to prescribe these medications carefully and optimize the safety of those patients who rely on opioids chronically. I look forward to working with policymakers and fellow physicians to find solutions to our country’s growing opioid epidemic.