Pill Addiction a Growing Epidemic
While drug addiction used to be thought of as a problem affecting only certain groups, the new trend of prescription abuse tells another story. In fact, the U.S. Center for Disease Control and Prevention has termed such abuse as a “growing, deadly epidemic.”
Prescription painkillers, or opioids, are medications that reduce the intensity of pain signals reaching the brain and impact brain areas controlling emotion, thereby diminishing the impact of a painful stimulus. These medications act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, gastrointestinal tract, and other organs. In addition to reducing the perception of pain, opioids can produce drowsiness, mental confusion, nausea, and constipation. The drugs also affect the brain regions involved in reward, and some people experience a euphoric response to opioid medicines.
Opioid analgesics were involved in 16,651 overdose deaths in 2010 (the most recent reliable data), surpassing deaths from any other licit or illicit drug or drug class. A 2010 survey also found that about 22.6 million people (or 8.9 percent of Americans) aged 12 or older had used illicit drugs in the current or past month, with 5.1 million reporting use of pain relievers. Only 1 in 6 users of non-therapeutic opioids said they received the drugs via a prescription from a doctor. Between 2009 and 2010, the majority of individuals using prescription pain relievers nonmedically—that is, without a doctor’s prescription or solely for the feeling the drugs produced—reported obtaining the drugs from friends or family.
Opioid abuse has been growing for years. In 2008, for the first time since at least 1980, poisoning deaths represented the top cause of injury death (deaths resulting from forces external to the body such as drowning, suffocation, or burning) in the U.S.—and even surpassed the number of motor vehicle traffic deaths. That same year, opioid analgesics were involved in almost 15,000 deaths, versus about 5,100 deaths involving cocaine and about 3,000 involving heroin.
The Health and Human Services Response
The United States has made the topic of Opioid Abuse a mainstream subject. There is a trend for more government regulation regarding this class of drugs. I am not certain that is the right approach. Because making it hard to get painkiller type medication might prevent some from getting addicted, but that is not the problem right now. First, we need to treat the people who are already hooked on these drugs and give them a new way of living, that creates a lifetime of sobriety.
Our nation is in the midst of an unprecedented opioid epidemic. More people died from drug overdoses in 2014 than in any year on record, and the majority of drug overdose deaths (more than six out of ten) involved an opioid.1 Since 1999, the rate of overdose deaths involving opioids—including prescription opioid pain relievers and heroin—nearly quadrupled, and over 165,000 people have died from prescription opioid overdoses.2 Prescription pain medication deaths remain far too high, and in 2014, the most recent year on record, there was a sharp increase in heroin-involved deaths and an increase in deaths involving synthetic opioids such as fentanyl.
Prevention, treatment, research, and effective responses to rapidly reverse opioid overdoses are critical to getting the epidemic—a top priority for the U.S. Department of Health and Human Services (HHS). In March 2015, HHS Secretary Sylvia M. Burwell announced an initiative targeting three priority areas to tackle the opioid epidemic and help save lives. These include: improving prescribing practices, expanding access to and the use of medication-assisted treatment, and expanding the use of naloxone.
The HHS Opioid Initiative targets three key areas that build on efforts to address the opioid epidemic and seek to expand evidence-informed strategies that have the greatest potential for impact. As demonstrated below, much progress has been made in the last year; however, our ability to do more to turn the tide of the opioid epidemic is signi cantly limited without adequate funding to support expanding access for individuals with opioid use disorder to seek and complete treatment, and sustain recovery.
To help achieve the goals of the Opioid Initiative, the President’s budget requests $1.1 billion in new mandatory and discretionary investments over FY 2017 and FY 2018 to expand access to treatment, and prevent opioid misuse and abuse.
The Administration looks forward to working with the Congress to secure the funding needed to provide families and communities with the support they need for opioid abuse prevention and to ensure that treatment is available for those who seek it.
The Health and Human Services Administration Progress to Date
Opioid Prescribing Practices
In 2014, more than 240 million prescriptions were written for prescription opioids, which is more than enough to give every American adult their own bottle of pills. Raising further alarm, four in ve new heroin users started out by misusing prescription opioids.
- The Centers for Disease Control and Prevention (CDC) in March 2016 released its Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings.
- As of March 2016, CDC has awarded over $30 million to 29 states to improve safe prescribing practices, such as enhancing Prescription Drug Monitoring Programs (PDMPs), through its Prescription Drug Overdose (PDO) grants. CDC has recently released a funding announcement, which could expand to 50 states by the end of FY 2016.
- In January 2016, the Centers for Medicare and Medicaid Services (CMS) released an Informational Bulletin on Medicaid best practices for addressing prescription drug overdoses, misuse and addiction.
- In October 2015, the Administration announced that over 40 provider groups committed to training prescribers in safe prescribing. Since then, more than 60 medical schools and 191 nursing schools have committed to requiring their students to take some form of prescriber education in line with the CDC Guideline. In addition, the President issued a memorandum requiring all federal health care professionals who prescribe opioids to be appropriately trained.Medication-Assisted Treatment (MAT)MAT is a proven, effective treatment for individuals with an opioid use disorder. MAT has been shown to increase treatment retention, and to reduce opioid use, risk behaviors that transmit HIV and hepatitis C virus, recidivism, and mortality.
- In 2015 the Substance Abuse and Mental Health Administration (SAMHSA) made awards totaling $10.7 million to 11 high-burden states through their Medication-Assisted Treatment for Prescription Drug and Opioid Addiction program. Applications for the next round were due in May 2016, and awards will be made to an additional 11 states.
- The Health Resources and Services Administration (HRSA) awarded $94 million to 271 health centers in March 2016 to improve and expand substance use disorder treatment in underserved areas.
- In December 2015, the Agency for Healthcare Research and Quality announced up to $12 million will be available over several years to fund research projects to support implementation of MAT in rural primary care practices.
- SAMHSA published a notice of proposed rule-making in March 2016 seeking to expand access to treatment through an increase in the number of patients a quali ed physician may treat with buprenorphine.
- The U.S. Food and Drug Administration (FDA) in May 2016 approved Probuphine, the rst buprenorphine implant for the maintenance treatment of opioid dependence.
Quickly responding to an opioid overdose with the lifesaving reversal drug naloxone is critical. Expanding access to naloxone for rst responders and individuals likely to witness an overdose and training health care providers to prescribe naloxone to at-risk patients are essential actions to reverse the epidemic.
- HHS agencies continue to expand access to naloxone through grants to high-need, rural, and tribal communities. For example, in September 2015 HRSA awarded $1.8 million in grant funding to support expanding access to naloxone in 18 rural communities.
- FDA approved a “user-friendly” intranasal formulation of naloxone in November 2015. This followed FDA’s approval of an auto-injector formulation of naloxone in April 2014.
- In April 2014, SAMHSA sent a letter to State agencies that administer the Substance Abuse Block Grants (SABG) to clarify that at a State’s discretion, SABG funds could be used to purchase naloxone and cover costs associated with dissemination of overdose kits.
Opioid Prescribing Practices
While actions to address prescription opioid abuse must target both prescribers and high-risk patients, prescribers are the gatekeepers for preventing inappropriate access and providing appropriate pain treatment. The Administration continues to support mandatory prescriber education on the use of opioids for pain management. In addition, the FY 2017 President’s Budget request includes:
• $80 million, an increase of $13 million, to support the improved uptake of CDC’s new Guideline among providers and ongoing support to all 50 states and D.C. through CDC’s prescription drug overdose activities.
• $5 million in funding for the Of ce of the National Coordinator for Health IT (ONC) to harmonize technical standards in support of integration of PDMPs with health IT systems, improve clinical decision-making, and further the adoption of electronic prescribing of controlled substances.