War on Drugs and the Opioid Epidemic

War on Drugs and the Opioid Epidemic

INTRODUCTION

According to data by the CDC (2018), an average of 128 people dies every day in the United States as a result of an opioid overdose. Addiction to and misuses of opioids as well as prescription pain relievers, and heroin has become a national crisis in the United States. The crisis has considerable impacts on the nation’s public health as well as its social and economic welfare. Opioid misuse alone has contributed to a financial burden of over $78.5 billion every year (Florence et al. 2016). This burden includes costs attributed to criminal justice involvement, health care costs, addiction treatments, and lost productivity.  According to the National Survey on Drug Use and Health, over 10.3 million people misuse prescription opioids in the United States every year. Out of this number, 2 million get opioid use disorders (McCance-Katz 2019). The increased use of opioids has also contributed to the spread of highly infectious diseases like HIV and hepatitis C due to injection drug use. Other consequences of opioid use include rising cases of neonatal abstinence syndrome due to opioid misuse by pregnant women. These devastating results of opioid use have led to the government declaring it a national epidemic. There is a need for a great emphasize on the control and prevention of opioid abuse through increased physician leadership, pharmaceutical companies’ cooperation, and increased regulatory measures on the use of opiates.

BACKGROUND

Much of what is known about the use of opioid for relieving pain is recent knowledge, although the field is rapidly evolving. Before 1800, pain was regarded as an existential phenomenon and a result of ageing (Meldrum 2003). There existed no regulations for the use of opioids or cocaine resulting in the widespread prescribing of the opiates for many illnesses, including minor ones such as toothaches. Due to this extensive and unregulated prescribing of opioid, there emerged a sudden rise of heroin abuse in the streets which led to the Harrison Narcotic Control Act of 1914 (Meldrum 2003). This Act was passed to help control and avoid the use of opiates. The Act restricted the prescription of opiates to patients. This phobia for opioid treatment was carried into the twentieth when there was a general worldwide “opiophobia”. The phobia led to under-reliance of opiates in the treatment of pain, which resulted in under-treatment of pain in patients, especially those with major diseases like cancer.

The under-treatment led to the research by pharmaceutical companies and different medical societies which reassured prescribers that the risk of addiction associated with opioid prescription was very low (Baker 2017).  This led to the first wave of the opioid crisis due to the rise of opioid prescriptions and medications for pain treatment. Pharmaceutical companies also started promoting the use of opiates on patients with pain that was not related to cancer even though they did not provide enough data to back up their claim (Tucker 2004). By the end of the twentieth century, almost 90% of patients using opiates had non-cancer related pain. Policies were again developed to regulate the use of opiates. However, a new wave of opioid epidemic emerged in 2010 after a rapid increase in cases of deaths due to heroin abuse. Deaths due to opioid misuse have continued to escalate since.

PREVENTING AND CONTROLLING

Increased physician Leadership

Increased physician leadership is substantial in the war on drugs and opioid use. Regulations or no regulations, physicians are a crucial part in controlling the abuse of opioids as they are the people responsible for the prescription of the drugs (CDC 2018). Physicians, therefore, must stay ahead of the lawmakers by looking for ways of ensuring the compliance of patients to treatments involving opioid prescriptions. This may prove to be a difficult task for physicians as they need to find the balance between under-treatment of pain in patients while at the same time ensuring patient compliance and avoiding over-prescription. According to the AMA Taskforce (2018), physicians should be encouraged to acquire the necessary training and education so as to improve their effectiveness during the treatment of patients with pain and substance use disorders.

Physicians should also seek to register for prescription drug monitoring programs (PDMPs). These programs help the physicians in making better informed prescribing decisions so that they do not end up harming the patients by subscribing an overdose of the pain-relieving drugs (Patrick et al. 2016). This will go a long way in helping reduce the opioid pandemic as a majority of cases result from wrong prescriptions to patients by uninformed physicians during treatment.  Physicians should also be encouraged to educate their patients about the safe use of the prescribed opioids to avoid misuse. They also have a significant role to play in educating the patients in the best storage practices as well as disposal methods for unwanted prescriptions (AMA 2018). Physicians should also ensure that they closely monitor their patients to ensure overdose and misuse are avoided.

Physician advocacy in the war against opioid abuse also involves the promotion and encouragement of physicians to administer naloxone to patients at the risk of overdose. The use of naloxone has been a success in public health though many physicians are still reluctant to use it on patients. In response to this, the AMA Opioid Task Force recommends the use of co-prescribed naloxone by professionals. The body has provided a guide to physicians on how to prescribe the drug when it is clinically appropriate. The decision on whether the use of naloxone is recommended should be made between the physician and the patient. A majority of people’s exposure to opioids that lead to addiction begins at the hospitals, an indication that there is a need for an increased evaluation of patients by physicians before deciding to prescribe the drugs to patients.

Government Regulation

One primary reason for the rapid increase in opioid substance abuse and misuse is to lack of proper regulative measures on its prescription and use. There is, therefore, a need for a shift in the strategies that the government and other regulatory bodies use in addressing the opioid crisis in order to properly address the crisis. Though opioid addiction is still a menace in the nation, it is important to acknowledge that substantial progress has been made over the past few years on the use of opioids as a pain reliever. The government and regulatory bodies should ensure not to eradicate this significant progress while introducing new strategies to address the issue (IASP 2010).  New regulatory measures should be developed while keeping in mind the moral duty of physicians to treat patients and the right of a patient to access pain treatment.

Studies have shown that medication-assisted treatment (MAT) is an effective way of helping recovering patients and preventing death due to substance use disorder. However, despite this evidence, legislative barriers still exist that restrict access to MAT and make it unaffordable. Such barriers include high cost-sharing for MAT and prior authorization requirements (Jones 2019). Patients who are ready to start MAT end up being delayed by restrictions like prior authorization requirements. Such delays could make the difference between recovery and continued abuse or even death. Such barriers are unjustified and should be removed to help patients gain access to MAT. With such barriers, it will be very difficult to win the fight against opioid abuse and addiction, especially during this time of the epidemic. These barriers can be removed by reducing MAT barriers in Medicaid and Commercial insurance.

In a bid to address the MAT barriers, the federal, federal governments should expand the role of the attorney general and state legislatures in reducing MAT barriers. Attorneys general can play a vital role in using their office to remove barriers to care. Legislative initiatives can also be used to remove barriers to MAT (Moreland et al. 2020). A few states have already taken up legal initiative steps to remove MAT barriers. Multiple state legislative efforts should be used to put into place to remove prior authorization for MAT. Some states have already enacted legislation that removes prior authorization for MAT while ensuring the lowest cost-sharing MAT options (Courtemanche 2019). However, very few states have enacted such legislation and other states need to emulate them so as to help win the war against opioid.  Insurance companies should also be encouraged to cooperate with the state in implementation of these legislations as their opposition to the new legislation is slowing down the process.

Research and Funding

Research is crucial in informing clinical practices surrounding the administration of opioids. States should ensure that resources are made available to help conduct extensive research that will ensure that policies been implanted are evidence-based and that patients are able to access quality care (AMA 2019). States and other bodies should ensure increased sufficient funding of research dealing with opioid misuse and addiction. NIH has been on the front-line in doing these by doubling their funding towards research on opioid (AMA 2019). Data collection on the extent of opioid prevalence should also be accelerated so as to enable the provision of the latest available information on the rates of opioid prescribing, substance use disorders, and overdose deaths. This data is substantial in making informed decisions on the actions to be taken in addressing the issue.

In order to reduce the rates of opioid addiction and overdose deaths, the public health department should work to ensure that patients have easy access to health care. Treatment for opioid addiction should also be made affordable for all patients seeking treatment (Smith 2019). This can be done by looking for donors to form different governmental and non-governmental organizations. According to data from (HHS 2019), HHS has on the front run in donations as it has already issued $800 million in grants to help in treatment. These donors can contribute in different ways towards the support of treatment, prevention and recovery efforts. The fight against the opioid epidemic is going to be a very expensive one if the desired results are to be achieved. Increased efforts to mobilize donor funding will, therefore, be essential.

Role of pharmaceuticals

Role of stakeholder Organizations

Improving access to treatment

Role of the public

Conclusions

References

American Medical Association. National Roadmap on State-Level Efforts to End the Opioid Epidemic Leading-edge Practices and Next Steps, AMA; 2019. https://www.end-opioid-epidemic.org/wp-content/uploads/2019/09/AMA-Manatt-National-Roadmap-September-2019-FINAL.pdf

American Medical Association. Reversing the opioid epidemic. Explore current resources from the AMA Opioid Task Force to help reverse the nation’s opioid epidemic, AMA; 2018. https://www.end-opioid-epidemic.org/education/

Baker, D. W. (2017). History of The Joint Commission’s pain standards: lessons for today’s prescription opioid epidemic. Jama, 317(11), 1117-1118.

CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2018. https://wonder.cdc.gov.

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., Zapata, D., & Fazlul, I. (2019). The three‐year impact of the Affordable Care Act on disparities in insurance coverage. Health services research, 54, 307-316.

Florence, C., Luo, F., Xu, L., & Zhou, C. (2016). The economic burden of prescription opioid overdose, abuse and dependence in the United States, 2013. Medical care, 54(10), 901.

International Association for the Study of Pain, IASP; (2010). Declaration of Montréal.

Jones, C. M. (2019). Syringe services programs: an examination of legal, policy, and funding barriers in the midst of the evolving opioid crisis in the U.S. International Journal of Drug Policy, 70, 22-32.

McCance-Katz, E. F. (2019). The National Survey on Drug Use and Health: 2017. Substance Abuse and Mental Health Services Administration. https://www. samhsa. gov/data/sites/default/files/nsduh-ppt-09-2018. pdf. Accessed May, 7.

Meldrum, M. L. (2003). A capsule history of pain management. Jama, 290(18), 2470-2475.

Meldrum, M. L. (2003). Opioids and pain relief: a historical perspective.

Moreland, A., McCauley, J., Barth, K., Bogdon, C., Killeen, T., Haynes, L., … & Brady, K. (2020). Assessing the needs of front-line providers in addressing the opioid crisis in South Carolina. Journal of substance abuse treatment, 108, 4-8.

Patrick, S. W., Fry, C. E., Jones, T. F., & Buntin, M. B. (2016). Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates. Health Affairs, 35(7), 1324-1332.

Smith, E., Q. K. (2019). Planning for the opioid crisis: how four cities approach zoning of healthcare-related facilities (Doctoral dissertation).

Tucker, J. D., & Kathryn, L. (2004). Medico-Legal Case Report and Commentary: Inadequate Pain Management in the Context of Terminal Cancer-The Case of Lester Tomlinson. Pain Medicine, 5(2).

U.S. Department of Health and Human Services. Better prevention, treatment & Recovery Services. HHS.; 2019. https://www.hhs.gov/opioids/about-the-epidemic/hhs-response/better-access/index.html