The Opioid Epidemic: How Physicians Can Take Action

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“Our nation is in crisis.” This strong statement opens an interim report released last week from the Commission on Combating Drug Addiction and the Opioid Crisis. The commission, led by New Jersey Governor Chris Christie, was created in March 2017 to work on ways to combat America’s ongoing fight against the opioid epidemic, a top of mind issue for physicians all over the country.
Findings from the report, which uses data from the Centers for Disease Control, are sobering; 142 Americans die every day from drug overdose and nearly two-thirds of these drug overdoses are linked to opioids like Percocet and OxyContin. The number of opioid overdoses has quadrupled since 1999.
Recent estimates from the New York Times shares that there were more deaths from drug overdoses in 2016 – at a current projection of 60,000 – than the total number American casualties in the Vietnam War. The Times report also estimates large increases in drug overdose deaths along the East Coast, including Maryland, Florida, Pennsylvania, and Maine. Certain states have been hit particularly hard; the state of Ohio has filed a suit against drug companies who they believe have assisted in the creation of this crisis.
There are many contributing factors that led to this point in the opioid crisis, with not one sole component to blame, but many physicians are asking what are the next steps are at this point in the epidemic?
Individual providers are taking action, in partnership with companies like LabCorp, to establish plans to test the compliance of opiate prescriptions. LabCorp has worked with providers to create profiles that fit a multitude of patients, whether that means testing for usage of opioids or compliance of opioids prescribed by the provider. Providers are, and increasingly need to, assume more responsibility for those taking them as prescribed, according to Clay Gipson, Ph.D., Vice President at LabCorp. Dr. Gipson shared that providers can do their part in the fight by increasing their own education on opioids, avoiding over-prescribing by ensuring prescriptions are warranted and enforcing testing on appropriate utilization. Providers prescribing opioids based on milligrams need to have a plan to test the compliance. For long-term patients, it’s best to test every three months during the first year, and every six months for the year after that.
Continuous education, also, is a huge benefit for all stakeholders. Opioids are often thought to be an issue that just plagues poor, rural communities, but addiction affects communities across many areas, with varying socioeconomic levels. While evidence for opioids has shown to be largely negative, they still can have a place in pain management. Lastly, educate patients struggling with addiction that opioid use disorder is manageable through recovery programs, and relapse is common but does not represent treatment failure.
There have been no federal mandates around opioid addiction but the commission, in its report, urges President Trump to declare a national state of emergency that would permit the executive branch to take immediate steps. The commission also provides recommendations, including waivers for all states to eliminate barriers to treatment, mandated prescriber education initiatives, and establishing and funding a federal incentive to enhance access to Medication-Assisted Treatment.
Certain states have started to put in requirements to try and combat this crisis. Governor Terry McAuliffe has already declared the opioid crisis a public health emergency in the Commonwealth of Virginia.  He has also signed bills that allow community organizations to dispense and train individuals to use naloxone, a drug that treats opioid overdoses, and mandate all opioid prescriptions to be transmitted to pharmacies electronically by 2020.
Other states, like Massachusetts, have chosen an alternative route, with the governing body urging the state to set up programs that would establish medically supervised injection clinics. These clinics would allow patients suffering from addiction to inject in an environment with medical supervision. The Boston Globe reports that some physicians in Massachusetts, a state that reportedly had more than 2,000 opioid-related deaths last year, believe these clinics can be a bridge to treatment and reduce drug use and paraphernalia in parks and streets.

As this crisis continues to evolve, President Trump received a formal briefing on the opioid epidemic from Tom Price, Health and Human Services Secretary. Health officials from some of the hardest hit states, along with the commission, hope for federal funding and intervention that will provide a light at the end of the tunnel, as President Trump vows to take a law-and-order approach to this crisis.

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