One of the more urgent problems facing the next president is the growing opioid epidemic. A generation of doctors prescribing more and more opioid-based pain medication has led to a startling spread of opioid addiction — and overdoses.
How bad is the problem? One town in West Virginia saw 28 overdoses in one 24-hour period in August.
Drug overdose was the leading cause of accidental death in 2014, according to the American Society of Addiction Medicine, and opioids accounted for nearly 40 percent of that total. Patients who once got prescriptions for Oxycontin to deal with chronic pain have often become hooked on the powerful medication. And once the scripts run out, they turn to heroin and illegally sold pills.
The wave of addiction has led to an alarming rate of overdose in America, according to Dr. John F. Kelly, the director of Massachusetts General Hospital’s Recovery Research Institute.“There are 80 people dying a day,” Kelly said.
While most efforts to combat the opioid epidemic happen at the local level — in emergency rooms and jail cells — the scale of the problem has grown into a national epidemic. The next president will have to act quickly once in office to try and reverse the deadly trend among opioid addicts.
“We have 5 percent of the world’s population, but we consume 85 percent of the world’s opioids..” Dr. John F. Kelly
“We have 5 percent of the world’s population, but we consume 85 percent of the world’s opioids,” said Kelly.
The next president could help combat the epidemic by following a three-pronged attack, said Kelly. Federal policy must help reduce supply, stem demand and increase overdose prevention.
“Those are the three legs of the stool designed to cut down on addiction and overdose,” he said.
According to Kelly, doctors must be much more aware of the power of opioid medication, and whenever possible prescribe alternatives for pain management.
“One of the issues is we have been too loose in prescribing very potent, and very seductive, medications,” said Kelly. “The goal is to find other analgesics that can address pain without causing addiction.”
Patients have a right to proper pain management, which means completely banning opioids is not a real solution. But limiting how often and how much doctors prescribe Oxycontin, Fentanyl and other opioid-based medications could help keep patients from becoming addicts. Prescribing other treatments, when available, is another option.
The next president could also work with insurance companies, pushing for policy changes that would make it easier for doctors to prescribe Suboxone and other drugs that block opioid receptors in the brain. CIGNA recently changed its policy, and now allows doctors to prescribe Suboxone without waiting for company approval.
“I think one of the big things is what happened with CIGNA has to happen with other companies, too. Often times, there’s a very narrow opportunity, when someone ends up in a hospital bed or some sort of accident happens because of opioid addiction, and sometimes these insurance companies don’t get back to [doctors] for days,” Kelly said. “If every insurance company could do that, and the government could put pressure on them to do that, it would save lives.”
There’s also the need for fast action when a patient is overdosing, said Kelly. The next president should work to make sure first responders, medical facilities and schools are all equipped with naloxone — marketed as Narcan — which can block opioid receptors in the brain and immediately reverse the effects of overdose.
“It knocks out or occupies those receptors. It can instantly revive someone,” Kelly said. “The opioid can shut down the brain stem. This knocks out that effect.”
Thankfully, addressing opioid addiction has been a nonpartisan issue, said Kelly. Both presidential candidates support efforts to provide Narcan to first responders, make it easier for doctors to prescribe opioid treatments like Suboxone, and control the volume of opioid prescriptions.
“This is one of the few things that people can agree on,” he said. “It was a Democrat and a Republican who wrote the [Comprehensive Addiction and Recovery Act of 2016]. That’s really good news that we can find consensus and public support.”
Massachusetts has been a leader in government action to combat the opioid addiction crisis, according to Kelly.
A new bill signed into law by Gov. Charlie Baker limits opioid prescriptions to seven-day supplies, requires medical facilities screen patients for signs of opioid addiction, and requires pharmacies to check with a statewide registry to try and combat doctor shopping, where patients visit multiple physicians to try and get multiple scripts for Oxycontin and other pain medications.
“Massachusetts is one of the leaders, thankfully,” Kelly said. “Gov. Baker has been fantastic in addressing it. Connecticut has been another leader along similar lines.”
A similar effort at the national level, led by the next president, could help to turn the tide. The changes won’t solve the problem overnight, but could help to reverse the trend, said Kelly.
“Everybody suffers from this. It’s not a partisan issue,” he said.