As opioid-related deaths continue to increase, one would be hard-pressed to find a community or person that has not been affected in some way by the continuing crisis. And as the epidemic rages on, finding ways to effectively navigate this public health emergency continues to be a challenge.
Yet in a promising turn of events, President Trump recently signed legislation that has potential to take a high-level, strategic approach to fighting the opioid crisis on several fronts. The package, Support for Patients and Communities Act directs much-needed resources to research and public health programs that aim to prevent and treat opioid use disorder. This includes funding for grants created to combat drug addiction at the state level, the creation of comprehensive opioid recovery centers, and desperately needed regulatory guidelines for recovery housing.
The opioid package, which passed the House 393-8 and the Senate 98-1, recognizes that these drugs have an important medical application for the treatment and management of pain. This acknowledges a crucial concern that many in the pain management field have raised: that some approaches to combating the opioid epidemic may actually be exacerbating the problem.
Until recently, emphasis has remained on limiting prescriptions. However, there is little evidence that this approach is effective. The underlying assumption used to be that opioid prescribing practices were the principal cause of the epidemic. Yet while opioid prescriptions have decreased since 2012, opioid overdose deaths have continued to increase. Prescribing practices may have been a part of the epidemic’s origins, but restricting prescriptions is clearly not going to be the solution.
In reality, prescription limits have put people at risk of untreated pain without addressing the more common ways that people come to abuse prescription opioids, such as through diversion or illegal importation. And unfortunately, it now appears that these limits have gone too far.
Instead of witnessing reduced rates of opioid use, the places hardest hit by these prescribing limitations have seen increasing rates of suicide. Several studies have demonstrated that chronic pain patients have increased thoughts of suicide, and are reported to mention suicide more frequently than patients without pain. The consensus in the medical community is that untreated pain frequently leads to depression and increased risk of suicide, so it follows that limiting the prescription of pain medications would result in these depressive and suicidal states.
Moreover, these conditions are often driven not just by the physical state of pain, but by the stigmatization of chronic pain. Moving forward, therefore, it is essential to eliminate stigma from the conversation about the opioid crisis and ensure that our policies do not place undue burden on the over 100 million Americans who have some form of chronic pain, many of whom are appropriately prescribed opioids.
While opioids are currently one of the most effective ways to address both acute and chronic pain, the future holds a lot of promise in the development of novel pain medications. The opioid bill signed last week recognizes this reality.
In addition to this measure, there has also been renewed focus on research and development of new, non-opioid analgesics. The Food and Drug Administration is now charged with developing an expedited pathway to usher these products into the market. Under the 21st Century Cures Act, analgesics that offer significant advantages over existing drugs — including lower risk of addiction, tolerance and dependence — can now be put into an expedited drug development pathway. This work is essential to the solution because, until we have better alternatives to opioids, patients will continue to need them — and the risk of misuse, abuse and addiction will continue.
Over the last few years, we have relied exclusively on reactionary, urgency-driven, blame-game, one-size-fits-all approaches. Despite pouring resources into the issue, these approaches have led to a worsening of the epidemic. As we look toward a future where all patients with pain receive appropriate treatment without the risk of addiction, we need to thoughtfully consider the potential implications of our policies and programs. The Support for Patients and Communities Act is a refreshing advance in this effort to combat the opioid crisis.
Image from Kimberly Boyles