Nearly 2 million people in the United States are addicted to prescription opioids. Addressing the opioid crisis lies in large-scale, integrated solutions, with endeavors from all relevant stakeholders—government, healthcare systems, pharmaceutical companies and non-profit organizations.

The U.S. Centers for Diseases Control and Prevention (CDC) reports that over 64,000 Americans died from drug overdoses in 2016, 21% more than the almost 53,000 the previous year. Nearly 40% of those overdose related deaths involved prescription opioids. As such, the US Drug Enforcement Agency (DEA) has declared opioid overdose a national epidemic.

What are opioids?

Opioids are a broad class of substances that bind to opioid receptors in the brain and body. They are moderate (hydrocodone, oxycodone) to strong (fentanyl) painkillers prescribed for pain relief following injury and surgery.

Due to their sedative and psychoactive properties, opoids are also used as recreational drugs, resulting in a widespread availability in the illicit drug market.

How did the opioid epidemic arise?

There are 3 main contributing factors that are behind the opioid epidemic:

1. Physicians are thought to be the primary contributor to the increase in opioid overdose and addiction, as they readily prescribe them for pain relief following injury and surgery. This has led to an increase in people who are becoming addicted to and dependent on these substances. Once doctors stop prescribing the medications, the addicted individuals likely seek the drugs from illegal sources.
2. Healthcare systems are also a key contributing factor. The U.S. healthcare structure, for example, is designed in such a way that encourages prescription drugs over expensive treatments or therapies. As a result, prescription rates for opioids in the US are 40% higher than the rate in countries such as Canada or Germany, where there is a universal healthcare system.
3. Finally, there is widespread availability of synthetic analog, counterfeit and adulterated drugs in the technology-driven illegal market.

Battling the pain: An integrated approach

The opioid epidemic impacts every sector of society. It strains healthcare resources and stresses welfare systems. Fighting the crisis is a complex undertaking as it requires efficient collaboration of many stakeholders such as government, families, law enforcement, educators, healthcare providers, drug companies, pharmacies, and taxpayers. According to a white paper published by Deloitte Center for Government Insights, curbing the crisis lies in large-scale, integrated solutions, with efforts from all of the above-impacted sectors. Such a collaboration offers insight into ingenious methods required to address this crisis.

Some examples of the collaborative approach are:

• Prevention efforts: This involves enforcing Prescription Drug Monitoring Programs (PDMPs) in the healthcare system.
• Treatment efforts: Such efforts aim to expand access to treatment of overdose admissions in hospitals, including the opioid antidote naloxone (Narcan, Evzio), which is used to rapidly reverse opioid overdose in an emergency situation.
• Awareness efforts: Appropriate training about substance use to students in health-related undergraduate and graduate programs, in addition to those in medical, pharmacy, nursing, and dental schools are being implemented. These efforts also include community awareness programs for children, patients, pharmacists, and doctors.
• Legal efforts: This focuses on working  to reduce and prevent charging individuals struggling with addiction under the criminal justice system and to enroll them in appropriate treatments. In particular, such efforts aim to reduce the illegal supply of opioids by the prosecution of those who prescribe/sell opioids illicitly.

What is being done by the drug companies?

The pharmaceutical industry has been accused of creating the epidemic, with some companies being suspected of intentionally understating the addictive properties of opioids. However, drug companies have recently started campaigns in an effort to reduce opioid misuse.

In a public-private partnership, 17 drug and biotech companies have committed to share 40 different compounds with each other to help develop safe, non-addictive pain treatments, as well as therapies to overcome addictions. Prominent examples of such efforts include:

1. Pfizer and Eli Lilly have joined to develop a non-opioid chronic pain medication, named tanezumab. Tanezumab is currently being tested in 7,000 patients in late-stage clinical trials, and the companies anticipate results on the trials by end of 2018.
2. Trevena is developing oliceridine, a compound derived from leaves of the Southeast Asian kratom plant, that has shown less incidence of addiction in animal trials. The product has been given preferential regulatory treatment by the FDA.
3. Titan and Braeburn have developed the first-ever skin implant, Probuphine, to treat opioid addiction.

America’s Health Insurance Plans (AHIP), a national trade association representing the healthcare industry, formed a workgroup to share best practices for treating opioid substance use disorder and developing advocacy efforts.

In 2016, insurance giant Cigna announced a “commitment to combat” program in order to alleviate opioid use among users by 25% over 3 years. In April 2017, it reported a reduction of nearly 12% in the past 12 months.

What’s next?

Even as the number of deaths due to opioid abuse continues to rise, doctors cannot completely stop prescribing them to patients due to a lack of alternative pain management treatments. Integrated programs such as those described above and new non-opioid drugs must be able to quickly engage the diverse impacted sectors for effective battle of the epidemic.

Although such collaborations between various sectors and stakeholders have started, gaining each others’ trust to share good practices, build efficient partnerships, and determine barriers will take time. Project Lazarus is a great example. It was implemented in its first phase from 2005-2011 in Wilkes County, NC. It follows these five components:

1. Community activation
2. Monitoring and surveillance data
3. Prevention of overdoses
4. Use of rescue medication for reversing overdoses by community members
5. Evaluating project components.

Four years into the implementation of Project Lazarus (2005-09), preliminary unadjusted data for Wilkes County showed that the overdose death rate dropped from 46.6 per 100,000 in 2009 to 29.0 per 100,000 in 2010.  

Featured image courtesy of Marco Verch on flickr.com.

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