Although the most recent data from the Centers for Disease Control and Prevention show that 33,000 Americans died in 2015 from an opioid overdose, a 2017 study of geographic trends finds that even this figure may be underestimated. A study of claims at Blue Cross Blue Shield found that the diagnosis of “opioid use disorder” jumped 493% from 2010 to 2016. And about 4.31% of Americans ages 12 or older use prescription pain relievers for nonmedical uses, according to combined 2012–2014 data from the National Survey on Drug Use and Health.
Prescription drug misuse and use of illicit opioids are tightly linked. For many, the use of heroin or synthetic opioids such as illegally manufactured fentanyl begins with prescription opioid misuse. In August, at the urging of the President's Commission on Combating Drug Addiction and the Opioid Crisis, President Trump declared the opioid crisis a national emergency. The designation makes additional federal public health funds available to hard-hit communities.
Among other federal government actions, the Drug Enforcement Administration is proposing to reduce the amount of controlled substances manufactured in 2018. It remains to be seen how such a curtailment in supply would play out in clinical settings, where opioids are needed to treat patients in severe pain.
Cities and states are taking their own actions. In 2015, Baltimore's health commissioner issued a standing order for naloxone—a rescue drug used to treat opioid overdose—to be available at all pharmacies; the move is credited with saving 800 lives. And a team from Brown University and the Rhode Island School of Design in Providence collaborated to design and produce emergency naloxone boxes, enabling any bystander to administer a rescue dose. Similar to how cardiac defibrillators are available for public use, some 48 NaloxBoxes are now installed at city social service centers where overdoses might occur. Meanwhile, New York has reached agreements with two insurance companies to end their requirements for prior authorization for medication-assisted treatments like methadone and buprenorphine. Such requirements can delay needed treatment.
A study published online on July 17 in JAMA Internal Medicine showed that a primary care intervention involving nurse care management, an electronic registry, education and feedback for prescribers, and electronic decision tools significantly increased guideline-concordant long-term opioid therapy and resulted in greater rates of opioid dose reduction and opioid discontinuation. The latest guidelines for opioid prescribing are available at www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm.—Joan Zolot, PA