The question of how to stem the nation's opioid epidemic now has a major detailed response. A new study chaired by University of Virginia School of Law Professor Richard Bonnie provides extensive recommendations for curbing the problem.
Drug overdoses are the leading cause of unintentional death in the United States, and opioids are the chief contributor. Between 2011 and 2015, overdose deaths from illicit opioids increased from 7,019 to 19,884—almost threefold.
Bonnie chaired the study for the National Academies of Sciences, Engineering and Medicine.
"This is an urgent matter," he said. "Ninety people die every day of an opioid overdose. We need to muster an 'all hands on deck' response to it, and the response needs to be sustained."
An ad hoc committee of pain-management, opioid-misuse and other public health experts, including UVA Law Professor Margaret Riley, convened in March 2016 at the request of the Food and Drug Administration to examine two challenges that fuel the epidemic: the need for opioids to treat pain and the need to reduce harms when the drugs are not used as intended. The committee's analysis and recommendations were presented to the FDA and at several Congressional briefings Wednesday and were released to the public on Thursday.
Release of the Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse report was accompanied by an invited "viewpoint" column in the Journal of the American Medical Association.
In the report, the committee urges efforts to educate prescribers, patients and the general public on alternatives to opioids, as well as the risk factors of their use.
Reducing the prescribing of opioids has already begun, Bonnie said. But when addicted patients are taken off prescription opioids, they often seek and find substitutes in the illegal market. The number of deaths due to heroin overdose is steeply going up in tandem with the efforts to reduce prescribing, the report shows.
"The epidemic has gotten more complicated because of the intersection of legal and illegal markets," Bonnie said. The increased use of illegal fentanyl, which is more potent and more dangerous than heroin, is very alarming."
The committee also recommends using evidence-based medical treatment for almost 2.6 million people who have "opioid use disorder" and emphasizes that providing access to treatment is an "ethical imperative."
But medications for treating addiction can be expensive. Congress' consideration of expanding Medicaid to help combat the problem is vitally important, Bonnie said.
"It's actually quite heartening that we have bipartisan support for doing something about this problem," he said.
The report also urges states to remove financial and legal impediments to access to naloxone, the drug used to save the lives of people who have overdosed.
The committee recommends additional research into non-addictive analgesic alternatives to opioids and non-pharmaceutical options such as massage therapy and yoga.
Additionally, an expansion of the FDA's regulatory vision will aid the agency in systematically considering public health concerns when making their decisions, Bonnie said. To this end, the committee has recommended specific ways in which the agency can incorporate concerns about the risk of addiction, overdose, diversion of drugs from the health care system and other harms into their decision-making process.
One of those ways is for the FDA to conduct a systematic review of all opioids currently on the market.
"We need a broader regulatory approach and more aggressive monitoring of what happens in practice after the drugs are on the market," Bonnie said.
The problem won't be solved overnight, he said.
"It took about 20 years for this epidemic to get to the point where we are," Bonnie said. "And it's going to take many years to unwind it. So we really need to stay on this. It can't be one of those things with a short political attention span. It's very serious and it's going to be very serious for a long time."
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Richard J. Bonnie et al. Both Urgency and Balance Needed in Addressing Opioid Epidemic, JAMA (2017). DOI: 10.1001/jama.2017.10046