Calls for change in how the US health care industry treats pain and drug abuse are gaining volume as the opioid epidemic worsens. Opioid drugs, mainly prescription painkillers and heroin, were responsible for 61% of the 47,055 overdose deaths in 2014 (the most recent year with public data), marking the second year that overdose deaths surpassed motor vehicle fatalities as the leading cause of injury death.
Calls to action are intensifying on several fronts:
Physicians must change prescription writing practices to reduce opioid accessibility. The FDA, CDC, American Medical Association (AMA), and other organizations are pushing prescription-writing health professionals — including primary care doctors, physician assistants, and specialists — to reduce the number of opioid prescriptions issued and limit the dosage and duration of prescriptions that are written. The CDC recommends offering alternative treatments such as non-opioid painkillers and physical therapy. The AMA also encourages doctors to work compassionately to reduce opioid exposure in patients already on chronic opioid therapy, identify and assist patients with opioid use disorder in obtaining treatment, and prescribe an overdose antidote (naloxone) to at-risk patients. The FDA has added boxed warnings to immediate-release opioid painkillers and is looking at updating the controlled-substance licensing process to include mandatory opioid-abuse training.
Treatment clinics require resources to accommodate all who seek help. Substance abuse centers, which depend heavily on government funding, often have to turn away patients when beds are full or understaffed. Facilities struggle to attract and retain workers due to burnout and low pay. The US House and Senate have each passed bills that authorize millions in funding grants for abuse prevention and treatment programs. President Obama, who is pushing heavily for increased treatment resources, is expected to sign the combined legislation. Some factions believe that funding in the legislation won’t be enough to address immediate needs; amendments to add another $600 million in emergency funding failed in each chamber. The Obama administration has earmarked $1.1 billion in new funding for evidence-based prevention programs in its 2017 budget proposal. Some $400 million was allotted to curbing the opioid epidemic in the 2016 budget.
Also at issue is what forms of treatment and prevention should be used. The 2017 budget proposal is largely geared towards expanding access to medication-assisted treatment, a sometimes controversial practice where clinics use opioid-based medications alongside counseling to ease a patient away from addiction. Discussion of injection clinics, where heroin addicts can shoot up with supervision from health professionals who can administer antidotes (and refer patients to detox), has resurfaced; this method has served to reduce overdose deaths in other nations.
Hospitals are overburdened with opioid-related cases. Hospitalizations related to opioid use and dependence jumped from 302,000 in 2002 to 520,000 in 2012, and costs have quadrupled to nearly $15 billion, according to a recent study. A majority of patients with opioid-related conditions have limited or no insurance coverage. The study’s findings highlight the treatment and cost burdens placed on hospitals and the need for more efficient treatment and better prevention measures. Several states have increased funding for prevention programs, including equipping first responders with antidotes, setting up community collection boxes for unused prescriptions (many abusers obtain medicines from friends or relatives), and establishing syringe-exchange programs to reduce cases of severe infection. Some state legislatures have reduced the cap on opioid prescriptions from 30 days to 7 days, and others have made antidotes available over the counter.
Training hospital employees to identify at-risk patients and improving programs that guide patients toward treatment are critical. Lack of follow-up care for overdose survivors is a major frustration for hospital and emergency response workers. A new program in New Jersey works to fill the gap by employing recovery specialists to work with hospitals and law enforcement agencies to reach overdose survivors and get them into immediate recovery and rehabilitation programs.
Pharmaceutical manufacturers shift production to low-risk painkillers. Pharma manufacturers have been under pressure for years to create abuse-resistant opioid and non-opioid painkillers. Companies have already seen a slowdown in revenue from traditional painkillers, many of which are generic, and reap greater profits from newer abuse-resistant and non-opioid painkillers still under patent protection. Makers of medication-assisted treatment drugs methadone and buprenorphine will likely see increased demand as federal funding for substance abuse clinics increases.
Public perception of addiction is shifting from a negative stigma to a treatable health condition as officials nationwide work to reduce opioid-related deaths. To facilitate the change, health care providers must adhere to new prescription guidelines and direct at-risk patient towards needed medical and mental health resources. Government funding will be essential in bulking up the network of substance abuse clinics and other treatment and prevention programs across the US.
Anne Law has been a member of the D&B editorial department for more than a decade, providing content for the Hoover’s and First Research products. She currently covers the health care and insurance industries for First Research. For industry news, follow Anne on Twitter.