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Steps to Address the Opioid Addiction Epidemic

JAMA; ePub 2017 Oct 24/31; Kolodny, et al

Publish date:

Effective programs to address the opioid addiction epidemic in the US need to address the prevention of addiction among people not currently addicted, and treatment and risk reduction to prevent overdose and death among those currently addicted. This according to a recent viewpoint in which the authors offered the following 10 steps the federal government should take to reverse the opioid addiction epidemic in the US.

  1. Improve surveillance of possible opioid addiction.
  2. Improve reporting of and response to opioid-related overdoses and fatalities.
  3. Promote more cautious prescribing for acute pain.
  4. Change labeling for chronic pain and restrict or eliminate marketing of opioids for this indication.
  5. Increase insurance coverage of and access to non-opioid and nonpharmacological management of pain.
  6. Interrupt the supply of heroin and illicitly produced synthetic opioids and improve coordination between legal and public health authorities.
  7. Identify possible opioid addiction early and link individuals to treatment.
  8. Expand low-threshold access to opioid agonist treatment.
  9. Implement harm reduction measures for current users, including access to clean syringes and naloxone.
  10. Consider removing ultra-high dosage-unit opioid analgesics from the market.

The authors concluded that rapid implementation of these 10 steps could enable tracking and reduction of both new opioid addiction and fatal overdoses.

Citation:

Kolodny A, Frieden TR. Ten steps the federal government should take now to reverse the opioid addiction epidemic. JAMA. 2017;318(16):1537–1538. doi:10.1001/jama.2017.14567.

Commentary:

Prescriptions for, as well as deaths from, opioid use have increased 4-fold over the last 20 years, leading to the current opioid crisis.1 Currently, nearly 100 million people in the US receive a prescription for opioids each year, and in 2015 there were approximately 33,000 deaths from opioid overdoses.2 This number of deaths is only slightly lower than the number of deaths from sepsis each year in the US.2 For our part, in the office, the critical recommendation of those above is #3: “Promote more cautious prescribing for acute pain.” A previous study showed that approximately 1 in 7 persons who received an opioid for acute pain and then received a refill were on opioids 1 year later.3 Empathic understanding of the difficulties of dealing with pain, but a knowledgeable and firm understanding of the importance of limiting the dose and duration of opioid prescriptions, is important as we discuss pain management with patients every day in the office. —Neil Skolnik, MD

  1. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription opioid use, misuse, and use disorders in US adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017;167(5): 293-301.
  2. Kochanek KD, Murphy SL, Xu J, Tejada-Vera. Deaths: Final data for 2014. Centers for Disease Control & Prevention. National Vital Statistics Report. 2016;65(4):1-121.
  3. Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. MMWR. 2017;66:265–269. doi:10.15585/mmwr.mm6610a1.

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Acute Illness and Cannabis Use in Adults, Ann Intern Med; ePub 2019 Mar 26; Monte, et al

Dual Receipt of Rx Opioids & Overdose Death, Ann Intern Med; ePub 2019 Mar 12; Moyo, et al

Opioid-Related Mortality in US by Opioid Type, JAMA Netw Open; 2019 Feb 22; Kiang, et al

Disparities in the Prescription of Opioids, JAMA Intern Med; ePub 2019 Feb 11; Friedman, et al

Prevention of Prescription Opioid Misuse in the US, JAMA Netw Open; 2019 Feb 1; Chen, et al