En español
NIDA

Menu

HHS leaders call for expanded use of medications to combat opioid overdose epidemic

New England Journal of Medicine commentary describes that vital medications are currently underutilized in addiction treatment services and discusses ongoing efforts by major public health agencies to encourage their use

April 24, 2014

A national response to the epidemic of prescription opioid overdose deaths was outlined yesterday in the New England Journal of Medicine by leaders of agencies in the U.S. Department of Health and Human Services.  The commentary calls upon health care providers to expand their use of medications to treat opioid addiction and reduce overdose deaths, and describes a number of misperceptions that have limited access to these potentially life-saving medications. The commentary also discusses how medications can be used in combination with behavior therapies to help drug users recover and remain drug-free, and use of data-driven tracking to monitor program progress.

Opioid-overdose deaths 1999-2010 showing upward linear trend starting at 4,030 in 1999, rising to 16,651 in 2010Number of prescription opioid related deaths 1999-2010
Source: CDC WONDER

The commentary was authored by leaders of the National Institute on Drug Abuse (NIDA) within the National Institutes of Health, the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Medicare and Medicaid Services (CMS).

“When prescribed and monitored properly, medications such as methadone, buprenorphine, or naltrexone are safe and cost-effective components of opioid addiction treatment,” said lead author and NIDA director Nora D. Volkow, M.D. “These medications can improve lives and reduce the risk of overdose, yet medication-assisted therapies are markedly underutilized.”

Research has led to several medications that can be used to help treat opioid addiction, including methadone, usually administered in clinics; buprenorphine, which can be given by qualifying doctors; and naltrexone, now available in a once-a-month injectable, long-acting form. The authors stress the value of these medications and describe reasons why treatment services have been slow to utilize them. The reasons include inadequate provider education and misunderstandings about addiction medications by the public, health care providers, insurers, and patients. For example, one common, long-held misperception is that medication-assisted therapies merely replace one addiction for another – an attitude that is not backed by the science. The authors also discuss the importance of naloxone, a potentially life-saving medication that blocks the effects of opioids as a person first shows symptoms of an overdose.

The article describes how HHS agencies are collaborating with public and private stakeholders to expand access to and improve utilization of medication-assisted therapies, in tandem with other targeted approaches to reducing opioid overdoses.  For example, NIDA is funding research to improve access to medication-assisted therapies, develop new medications for opioid addiction, and expand access to naloxone by exploring more user-friendly delivery systems (for example, nasal sprays). CDC is working with states to implement comprehensive strategies for overdose prevention that include medication-assisted therapies, as well as enhanced surveillance of prescriptions and clinical practices. CDC is also establishing statewide norms to provide better tools for the medical community in making prescription decisions.

“Prescription drug overdoses in the United States are skyrocketing.  The good news is we can prevent this problem by stopping the source and treating the troubled,” said co-author and CDC director Tom Frieden, M.D., M.P.H. “It is critical that states use effective prescription drug tracking programs so we can improve prescribing practices and help get those who are abusing drugs into treatment.”

Charged with providing access to treatment programs, SAMHSA is encouraging medication-assisted therapy through the Substance Abuse Prevention and Treatment Block Grant as well as regulatory oversight of medications used to treat opioid addiction. SAMHSA has also developed an Opioid Overdose Toolkit to educate first responders in the use of naloxone to prevent overdose deaths. The toolkit includes easy-to-understand information about recognizing and responding appropriately to overdose, specific drug-use behaviors to avoid, and the role of naloxone in preventing fatal overdose.

“SAMHSA’s Opioid Overdose Toolkit is the first federal resource to provide safety and prevention information for those at risk for overdose and for their loved ones,” said co-author and SAMHSA Administrator Pamela S. Hyde, J.D. “It also gives local governments the information they need to develop policies and practices to help prevent and respond appropriately to opioid-related overdose.”

CMS is working to enhance access to medication-assisted therapies through a more comprehensive benefit design, as well as a more robust application of the Mental Health Parity and Addiction Equity Act.

“Appropriate access to medication-assisted therapies under Medicaid is a key piece of the strategy to address the rising rate of death from overdoses of prescription opioids,” said co-author Stephen Cha, M.D., M.H.S., chief medical officer for the Center for Medicaid and CHIP [Children’s Health Insurance Program] Services at CMS.  “CMS is collaborating closely with partners across the country, inside and outside government, to improve care to address this widespread problem.”

However, the authors point out that success of these strategies requires engagement and participation of the medical community.

The growing availability of prescription opioids has increased risks for people undergoing treatment for pain and created an environment and marketplace of diversion, where people who are not seeking these medications for medical reasons abuse and sell the drugs because they can produce a high.

More than 16,000 people die every year in this country from prescription opioid overdoses, more than heroin and cocaine combined. According to SAMHSA’s 2012 National Survey on Drug Use and Health, almost 2.1 million people in the United States were dependent upon or abusing opioid pain relievers.  More information on prescription opioid abuse can be found at:  www.drugabuse.gov/publications/research-reports/prescription-drugs.

Reference: Medication-Assisted Therapies — Tackling the Opioid-Overdose Epidemic. Nora D. Volkow, M.D. (NIDA), Thomas R. Frieden, M.D., M.P.E. (CDC), Pamela S. Hyde, J.D. (SAMHSA), and Stephen Cha, M.D., M.H.S. (CMS). The New England Journal of Medicine, April 23, 2014: www.nejm.org/doi/full/10.1056/NEJMp1402780.


Contact:
NIDA Press Office
301-443-6245
media@nida.nih.gov

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at www.drugabuse.gov. To order publications in English or Spanish, call NIDA's new DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or fax or email requests to 240-645-0227 or drugpubs@nida.nih.gov. Online ordering is available at drugpubs.drugabuse.gov. NIDA's media guide can be found at www.drugabuse.gov/publications/media-guide, and its new easy-to-read website can be found at www.easyread.drugabuse.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH. . .Turning Discovery Into Health®

Tags

This page was last updated April 2014

News Releases

Sep 2014

Aug 2014

Jul 2014

Jun 2014

May 2014

Apr 2014

Mar 2014

Feb 2014

Jan 2014

Dec 2013

Nov 2013

Oct 2013

Sep 2013

Aug 2013

Jul 2013

Jun 2013

May 2013

Apr 2013

Mar 2013

Feb 2013

Jan 2013

Dec 2012

Nov 2012

Oct 2012

Sep 2012

Aug 2012

Jul 2012

Jun 2012

May 2012

Apr 2012

Mar 2012

Feb 2012

Jan 2012

Dec 2011

Nov 2011

Oct 2011

Sep 2011

Aug 2011

Jul 2011

Jun 2011

May 2011

Apr 2011

Mar 2011

Jan 2011

Dec 2010

Nov 2010

Sep 2010

Aug 2010

Jul 2010

May 2010

Apr 2010

Mar 2010

Jan 2010