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HHS Announces Actions to Attack the Opioid Abuse Crisis

March 26, 2015

photo of opium poppies

Opioid abuse and overdose deaths have reached crisis proportions in the United States. Deaths from opioid painkillers now exceed all other drug overdose deaths, and we are seeing increases in heroin use and increased deaths from heroin as people addicted to painkillers transition to this cheaper, more potent street drug. More must be done to confront the opioid crisis head-on.

Today, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced a new initiative to reduce overdose, death, and addiction as a result of opioid drugs. The measure focuses on three areas: helping healthcare providers make better pain-management decisions to prevent overprescribing; increasing availability and use of the opioid antagonist naloxone; and enhancing use of effective medication-assisted treatments for opioid addiction.

The new initiative will enhance provider education by creating legislation to require training in safe opioid prescribing and creating prescribing guidelines for chronic pain. Although opioids are widely prescribed for chronic pain, which affects more than a third of Americans, recent research suggests they may not be optimal treatments and may even make some conditions worse (see my previous post - Opioids and Chronic Pain—A Gap in Our Knowledge). The initiative will also support more widespread use of state prescription drug monitoring programs (PDMPs) and other measures to track opioid prescribing and prevent diversion.

The initiative will also support developing new naloxone products and delivery systems and provide incentives for states to purchase naloxone and train first responders in using it. As I’ve discussed before on this blog (Naloxone—A Potential Lifesaver) , naloxone can be the difference between life and death for a person whose respiration has stopped because of a painkiller or heroin overdose. Naloxone is a safe, potentially very easy-to-use drug that has already reduced overdose deaths in cities where pilot programs distributing it to opioid users and their relatives have been tried.

Promoting wider use of medication-assisted treatment, the third prong of the initiative, is crucial. Methadone, buprenorphine, and naltrexone (especially the long-acting injectable formulation) are highly effective treatments for opioid addiction, yet they are offered by only a minority of treatment programs nationwide. Infrastructural impediments like insurance coverage limitations as well as unscientific attitudes about using medications to support recovery in people with addictive disorders have led to these treatments’ poor adoption. The new HHS initiative will launch a grant program to improve access to them, educate and train providers in their use, as well as explore policy changes to remove existing barriers.

Better pain prescribing, new naloxone formulations, and promoting medication-assisted treatments have been priorities for NIDA for some time. I am very excited to see the commitment and support at the highest levels of the HHS to address the opioid crisis in our country.

More information and links to detailed information about the new HHS actions.

This page was last updated March 2015

Comments

Chasing "pain"

Since the U.S. has only about 4.5% of the world's population but consumes over 80% of its prescribed opiates we cannot logically assert that pain is "under-treated" in the U.S. Yet, this has been the mantra for the last two and a half decades.

One of the critical problems has been the advocacy to treat pain - as if this is itself a goal of good medical care. It isn't. The correct goal is to treat illness that causes pain, and provide symptom relief as a sub-set of those processes. "Chronic pain" is not an illness. It is the label for a symptom and a duration. Good service focuses on understanding the illness.

Evolution created a neurophysiology wherein both physical pain (nociception) and emotional pain (anguish) are interconnected. This should be no surprise. When injury, potential injury, or illness are present then pain represents both the tissue problems and the associated social/emotional vulnerability. Thus all physical pain has its emotional aspects. Conversely, and less appreciated, emotional pain has its physical aspects. Very commonly chronic pain is much more an issue of existential anguish and much less an issue of structural disease. This accounts for the very many people where pain treatment is delivered for "chronic pain" and not for its causative illness.

It is actually fascinating that opioids work for emotional pain. In fact, most of the patients I treat for addiction report that they take opioids (when that is the drug of choice) to numb emotional pain. It works - temporarily. Yet, as we all know, such treatment does not lead to good outcome (a long discussion). The public thinks they take the drugs to "get high". Yet when you really understand their plight the deeper driver of the behavior is the desire to stop the low.

It's a long and interesting story. And, this isn't the place to explore its depths. So, let it suffice to say that while medicine is advocated to proceed under "First, do no harm" we might equally as well advocate, "First, made a diagnosis." Chasing symptoms is not the foundation of good medical care.

DEA does not do much to limit the supply of heroin

today I called the DEA at the request of my U.S. Senator regarding a scientific way of drastically reducing the supply of heroin. An executive at the DEA told me that the way that they limit heroin is to educate parents that drugs are bad then the parents educate their kids and then drug usage is reduced. I for one do not believe that this sesame street approach is working, perhaps its time to take reall action. I guess the D in DEA stands for "don't care" its too bad such a waste of tax dollars.

Recovery is a whole family process.

I was looking at a 12 step gazette article about how recovery is a family process. I agree with that to some degree, meaning I know that my addiction affected my family but I'm not sure if they did or were even open to getting any sort of support as family of an addict/alcoholic. I know that they love me today and that's all that matters.
Thanks for this great article, I hope they do crack down some, it's crazy in philly!

MAT

I agree that addicts need to have the full range of treatment options available to them. I feel strongly that individualized treatment is critical. There is no one size fits all. Having more access to MAT is also critical to help deal with the opioid addiction epidemic, but I find it disturbing to note that some experts who argue for more MAT seem to suggest that the only reason MAT is not used more is because of "stigma." Certainly, stigma is present and must be addressed, but the denial of the real world realities of MAT service delivery and patient misuse of these medications is unfair. If experts want MAT to be as available as (and fully integrated with) other forms of substance abuse treatment, then there needs to be a serious review of how some providers (suboxone docs and methadone clinics) treat patients. There is insufficient focus on the very real consequences of subscribing to an addict a substance on which they may become dependent and precious little focus on providing those patients with clinically safe methods to eliminate their need for these medications, if appropriate, over time. Yes, some addicts - particularly those with certain cooccurring illnesses - will need to take medications for the remainder of their lives. And the stigma against that is unfair. But I find the failure to provide any addict with drug free treatment options either initially or periodically while in treatment to be grossly unfair also. And using insulin as an analogy is an example of that unfairness. Ignoring the fact that many opiate addicts can remain drug free either initially, or after the use of some type of MAT, displays a lack of knowledge of the power and promise of recovery for those that take the behavioral steps to change their lives. Many do struggle with cravings and they should be addressed, but that should not require them to take medication for the remainder of their lives. The bottom line is that recovery is hard, but well worth the struggle. If some need medications to help their process, then they should have access to them, but don't assume that all addicts need medications or need them forever. Some people heal their bodies, minds and souls over time through treatment, prayer and the fellowship of AA/NA or similar groups.

The bad PR for some MATs is somewhat self inflicted. Look at the huge conflict of interest for the parent company of Alkermes in promoting both Vivitrol and Zohydro.

What needs to happen is the full integration of substance abuse/mental health treatment so patients have multi-disciplinary teams working together to meet their treatment needs including medication and therapy. Treatment assessment and planning needs to focus on all health and wellness aspects and that patients receive objective information about medication options where the educator does not have a financial reason to promote use of any particular drug.

And finally, I express these concerns because I believe that a failure of the pro and anti MAT treatment professionals to effectively integrate SA treatment for all patients will only lead to litigation that will force a legal, rather than a clinical resolution.

Holistic Approach

A mind , body and spirit approach is what we need. Get faith based organizations involved : support groups, referral to resources, spiritual and mental health counseling.

Find Help Near You

The following website can help you find substance abuse or other mental health services in your area: www.samhsa.gov/Treatment. If you are in an emergency situation, people at this toll-free, 24-hour hotline can help you get through this difficult time: 1-800-273-TALK. Or click on: www.suicidepreventionlifeline.orgExternal link, please review our disclaimer.. We also have step by step guides on what to do to help yourself, a friend or a family member on our Treatment page.

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