January, 2020.The magnitude of the opioid epidemic in this country is now well-known and is a national crisis. In this issue of the Journal, Flavin and colleagues report that, in the United States, “Opioids are the primary cause of death from drug overdose, accounting for 42,249 deaths in 2016. From 2016 to 2017, the rate of opioid overdoses increased by 30% in 45 states, with some states seeing a 70% increase.” These are alarming statistics. The increase in opioid deaths from 1999 to 2017, according to the United States Centers for Disease Control,1 which is discussed on the National Institute of Drug Abuse (NIDA) website,2 is illustrated in the graphic below.
Although many factors have contributed to this explosive crescendo, one main cause has been the increase in opioid prescribing for pain. The general concern, in the 1990s, that patients with chronic pain were being undermedicated, led to a new requirement by accrediting agencies, to record and monitor the level of pain for every hospitalized patient. Many patients may have benefitted from this practice, but an unintended consequence was the increase in the number of opioid prescriptions, due to the heightened demand for these highly addictive substances and for newer more powerful but more dangerous drugs such as fentanyl.
Clearly, this public health emergency has no simple solution. The US Department of Health and Human Services website3 outlines 5 priorities:
- Improving access to treatment and recovery services.
- Promoting use of overdose-reversing drugs.
- Strengthening our understanding of the epidemic through better public health surveillance.
- Providing support for cutting-edge research on pain and addiction.
- Advancing better practices for pain management.
In this issue of the Journal, Flavin and colleagues examine one important resource (pertinent to the first of the priorities listed above), the database of the Substance Abuse and Mental Health Services Administration (SAMHSA), identifying the state-by-state availability of practitioners officially qualified to prescribe buprenorphine, one of too few treatments that have been proven effective in the treatment of opioid addiction. Sadly, they found that, although the SAMHSA “buprenorphine practitioner locator” is intended as a resource for patients, only a small percentage of practitioners listed actually provided this treatment or, if so, had openings for new patients.
Also in this issue, Mahgoub and colleagues discuss the availability of different preparations of naloxone, an opioid antagonist (pertinent to the second of the priorities listed above). They describe an innovative program on an inpatient dual-diagnosis unit in New York to train patients and their families on the administration of naloxone spray, in the context of the unusual law passed in New York State that makes it legal for a nonmedical individual to administer naloxone spray as a life-saving intervention to a person who is acutely at risk from an opioid overdose.
Although a monumental crusade is necessary (and underway) to overcome this epidemic, efforts such as those described here are important voices in that immensely important campaign.
John M. Oldham, MD
1. Centers for Disease Control and Prevention (CDC)/National Center for Health Statistics. National Vital Statistics System, Mortality. Atlanta, GA: US Department of Health and Human Services, CDC WONDER; 2018. Available at: https://wonder.cdc.gov
. Accessed November 11, 2019.
2. National Institute on Drug Abuse (NIDA). Overdose Death Rates. Rockville, MD: NIDA; revised; 2019. Available at: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
. Accessed November 17, 2019.
3. Price TE. Secretary Price Announces HHS Strategy for Fighting Opioid Crisis. Presented at National Rx Drug Abuse and Heroin Summit, April 19, 2017. Atlanta, Georgia. Washington, DC: U.S. Department of Health and Human Services; 2017. Available at: https://www.hhs.gov/about/leadership/secretary/speeches/2017-speeches/secretary-price-announces-hhs-strategy-for-fighting-opioid-crisis/index.html
. Accessed November 17, 2019.