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Here’s What a Real Opioid Emergency Looks Like

Narcan nasal spray

Narcan, a nasal spray formulation of naloxone, approved by FDA (Adapt Pharma Ltd)

28 October 2017. On Thursday, President Trump declared the nation’s opioid drug crisis a public health emergency and called for a number of steps to address the crisis. But let’s be clear — the limited steps ordered by the president don’t look anything like a response to an emergency.

The Oxford English Dictionary defines “emergency” as “a serious, unexpected, and often dangerous situation requiring immediate action.” By this time, the opioid crisis is hardly a surprise, but every indicator shows it’s still dangerous and serious. A report by the National Academies of Sciences, Engineering, and Medicine in July 2017 spells out the scope of the crisis, with some 2 million Americans age 12 and older addicted to prescription opioid drugs and another 600,000 addicted to heroin.

The most visible and immediate effect of the emergency is the growing number of overdoses and deaths that result. National Institute on Drug Abuse, part of National Institutes of Health, cites data showing more than 90 Americans each day die from opioid overdoses, with an economic burden estimated at $78.5 billion a year from the costs of care, treatment, lost productivity, and criminal justice.

The National Academies’ report called for a “sustained, coordinated effort is necessary to stem the still-escalating prevalence of opioid-related harms”. The president’s action on Thursday are hardly sustained. In fact, the president was careful to declare a “public health emergency,” which according to Department of Health and Human Services lasts only 90 days, requiring renewals each time to stay active.

A public health emergency also makes available funds in a Public Health Emergency Fund to devote to the crisis. That fund, according to Time magazine, has only $57,000 at the moment, and the president’s declaration calls for no new funding. Time quotes Andrew Kolodny of the Opioid Policy Research Cooperative at Brandeis University who says an appropriation of $60 billion over the next 10 years would be a more appropriate response.

Some members of Congress introduced bills to spend more money on battling opioid addiction, but until those funds materialize, here are a few steps — including some reported in Science & Enterprise — that would show we ‘re taking seriously this opioid emergency.

Overdoses. FDA already approved a nasal spray to counter opioid overdoses. Let’s enlist the Red Cross and community groups nationwide to stock the nasal spray and train individuals in its use. The Red Cross teaches CPR so many individuals in communities can step in to save lives at home, work, or even on the streets. With 90 Americans dying from opioid overdoses each day, we need that same level of community involvement.

Treatment. New drugs that help patients withdraw safely from opioid addiction are now in clinical trials. One drug, a formulation of the drug buprenorphine given once a week is shown to block the effects of further opioid exposures and withdrawal symptoms. The drug, made by Braeburn Pharmaceuticals and Camurus AB in Sweden, acts on the same receptors in the brain as heroin and morphine, providing enough satisfaction of those receptors without producing the intense “high,” or serious adverse effects of abused drugs. If these new compounds continue to show success in late-stage clinical trials, regulators and the industry need to get them into the hands of treatment clinics without delay.

Medicaid. Recent data from the Kaiser Family Foundation (see infographic below) show 3 in 10 non-elderly individuals with an opioid addiction are covered by Medicaid, a federal-state insurance program for low-income families. All state Medicaid programs cover at least 1 of the 3 medications used in opioid addiction treatment programs, with most of these programs covering all 3 drugs. Thus, any serious attempt to end opioid addiction needs to continue funding Medicaid, which should give pause to recent attempts in Congress to make large cuts in Medicaid or repeal the Affordable Care Act that allows states to expand Medicaid.

Alternative pain management. The routine, automatic practice of prescribing opioid drugs for pain relief needs to be replaced by more careful attention to the individual needs of the patients, and better monitoring of their condition. The National Academies’ report recommends a change in the culture surrounding pain medications, including mandated training for health professionals dealing with pain and raising more awareness of options for pain relief among the general public. In addition, drug prescribers and pharmacists need to recognize and provide counseling to people susceptible to opioid use disorder or overdose.

The trend across the health care industry toward precision medicine could also help reduce routine prescriptions of opioids for pain relief. In June 2017, early results of a large-scale clinical trial show the use of genetic testing to guide medications at pain clinics indicates patients are experiencing less pain, with fewer individuals taking opioids. While these are just the first results from the trial, the findings suggest a more personalized and judicious approach to pain management can cut the use opioids.

Reduce the supply. Most of these ideas are designed to reduce the demand for opioid drugs, but what about the their supply? The National Academies report recommends making take-back programs for excess pain medications routine daily practice for pharmacies, and not special occasions held a few times a year. In addition, the panel that wrote the report warns against inadvertently feeding illicit heroin markets by taking draconian steps against prescription opioids. The report recommends coordinating limitations imposed on prescription drugs with more treatment programs, so people addicted to prescription opioids have better options than switching to heroin.

Costs. Taking more seriously the opioid crisis should help reduce the annual $78.5 billion burden on the U.S. economy, but carrying out even a few of these steps will still mean spending more taxpayer money. Congress today seems less interested in reducing the national debt, since it passed just this week a budget plan for the next fiscal year calling for tax cuts estimated to add $1.5 trillion to the debt over 10 years. By comparison, the cost of these measures to curb opioid addiction would likely be chicken feed.

Opioid crisis infographic

(Kaiser Family Foundation)

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