March 26, 2015
photo of opium poppies

Opioid abuse and overdose deaths have reached crisis proportions in the United States. Deaths from opioid painkillers now exceed all other drug overdose deaths, and we are seeing increases in heroin use and increased deaths from heroin as people addicted to painkillers transition to this cheaper, more potent street drug. More must be done to confront the opioid crisis head-on.

Today, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced a new initiative to reduce overdose, death, and addiction as a result of opioid drugs. The measure focuses on three areas: helping healthcare providers make better pain-management decisions to prevent overprescribing; increasing availability and use of the opioid antagonist naloxone; and enhancing use of effective medication-assisted treatments for opioid addiction.

The new initiative will enhance provider education by creating legislation to require training in safe opioid prescribing and creating prescribing guidelines for chronic pain. Although opioids are widely prescribed for chronic pain, which affects more than a third of Americans, recent research suggests they may not be optimal treatments and may even make some conditions worse (see my previous post - Opioids and Chronic Pain—A Gap in Our Knowledge). The initiative will also support more widespread use of state prescription drug monitoring programs (PDMPs) and other measures to track opioid prescribing and prevent diversion.

The initiative will also support developing new naloxone products and delivery systems and provide incentives for states to purchase naloxone and train first responders in using it. As I’ve discussed before on this blog (Naloxone—A Potential Lifesaver) , naloxone can be the difference between life and death for a person whose respiration has stopped because of a painkiller or heroin overdose. Naloxone is a safe, potentially very easy-to-use drug that has already reduced overdose deaths in cities where pilot programs distributing it to opioid users and their relatives have been tried.

Promoting wider use of medication-assisted treatment, the third prong of the initiative, is crucial. Methadone, buprenorphine, and naltrexone (especially the long-acting injectable formulation) are highly effective treatments for opioid addiction, yet they are offered by only a minority of treatment programs nationwide. Infrastructural impediments like insurance coverage limitations as well as unscientific attitudes about using medications to support recovery in people with addictive disorders have led to these treatments’ poor adoption. The new HHS initiative will launch a grant program to improve access to them, educate and train providers in their use, as well as explore policy changes to remove existing barriers.

Better pain prescribing, new naloxone formulations, and promoting medication-assisted treatments have been priorities for NIDA for some time. I am very excited to see the commitment and support at the highest levels of the HHS to address the opioid crisis in our country.

More information and links to detailed information about the new HHS actions.

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