An Overview of the Opioid Epidemic and Policy Options to Challenge the Status Quo
Last month, President Trump declared the epidemic a public health emergency. Rather than using the Stafford Act to declare the problem a national disaster, President Trump’s actions do not reflect the recommendations of his opioid commission and more importantly, the concerns of the general population. If Trump had declared the epidemic a national disaster, the government could immediately tap into funds from FEMA’s Disaster Relief Fund, but the current designation as a public health emergency forbids additional federal funding from being directed to the crisis. Opioid overdose deaths have increased by over 430% since 2000. In 2015, over thirty thousand Americans died from opioid overdoses. 1.9 million Americans and 122,000 teens are addicted to opioids, with an average of 52 Americans dying daily from the epidemic. We cannot wait for a sluggish federal government and a lifeless executive branch headed by a president who is reluctant to taking real action on any issue to properly address the opioid epidemic. State and local government must work toward immediate implementation of strategies to fight the epidemic.
This is the most fatal drug crisis in United States history, and many communities are left to suffer in its path. While the federal government is currently engaged in a discussion regarding its role in the epidemic, most of the current weight rests on the shoulders of state governments. To date, states have addressed the problem differently and to varying degrees. Laid out by the National Safety Council, six key indicators have been identified to measure individual state progress: mandatory prescriber education, opioid prescribing guidelines, pill mill elimination, prescription drug monitoring programs (PDMPs), access to Naloxone, and availability of treatment options. Evidence-based policies must be developed to effectively address all six indicators. With the implementation of these strategies at the state-level, significant progress can be made without involvement from the federal government.
Providers should make well-informed decisions on medical treatment based on best practice and the latest research, carefully weighing benefits and risks of opioids and their alternatives. Many physicians report receiving limited education on pain treatment. In the past decade, there has been an increase in opioid prescribing, despite a lack of corresponding decrease in reported pain. The causal link between physician training, patient health outcomes, and the increased prevalence of opioid prescribing demands that physician training addresses the reported lack of pain treatment education by making higher quality training more readily available. One way to do this is by requiring physicians to receive specific training to specifically prescribe opioids. The CDC has guidelines set for opioid treatment for chronic pain that can be adopted as state prescribing guidelines. During training, these guidelines should be shared with physicians, urging them to seek alternative, non-opioid strategies before opioid-based treatments. Without hindering the physician-patient relationship, physicians should be urged to seek evidence-based strategies and to limit the number of opioid prescriptions and prescription lengths. Hopefully, physicians will be better equipped to advise patients on pain treatment and alternative options to opioids.
Doctor shopping, or going to multiple providers who prescribe controlled substances outside the scope of standard medical practice, will continue to fuel the opioid epidemic. To eliminate pill mills, states should mandate that all prescribers report prescriptions to working PDMPs. PDMPs have shown to reduce overprescribing and doctor shopping, and eliminate pill mills. PDMPs have also been linked to increases in quality of care. Physicians can use substance use information to support clinical judgment and to increase confidence in prescribing. By providing PDMPs as a source of information for consultation by physicians, PDMPs can be properly implemented without affecting physician-patient privacy and without physician fear of legal retribution.
Many different strategies can and should be implemented to help existing victims of opioid addiction or abuse. Many health departments and police departments across the country issue Naloxone, an antidote to a heroin or painkiller overdose, for free. Administrations should follow by example and make such treatment options more readily available and accessible to the public. Medical marijuana has been effective in reducing reliance on prescription drugs and opioids. States with legalized marijuana reported a 24.8% drop in opioid death rate; dispensaries have been effective in decreasing the number of opioid-related deaths. The stigma associated with marijuana needs to be addressed so more states can pass medical cannabis laws, a better alternative to dangerous opioid prescriptions.
Many steps can be taken to curb the opioid epidemic. State and local governments should not defer to the federal government for action. State-focused, evidence-based policies have shown to help fight opioid abuse, and with more action, we can end the loss of life associated with this national disaster.
