Anthropology’s Lee Hoffer and Trustee Linda Burnes Bolton take stock of the opioid issue in federal report, while offering recommendations to curb the crisis
Though the total number of prescriptions for opiate medications have fallen, overdoses from the drugs, including its illicit forms, such as heroin and fentanyl, continue to rise—and are now the country’s leading cause of unintentional injury death.
To battle opiate-related trends, last year the National Academies of Sciences, Engineering, and Medicine (NASEM) convened an expert committee funded by the U.S. Food and Drug Administration (FDA) to take stock of the issue and propose potential actions to lessen the crisis.
Lee Hoffer, an associate professor of anthropology at Case Western Reserve University, and Linda Burnes Bolton, on the university’s Board of Trustees, were members of the NASEM committee that released its report in mid-July, which provides a snapshot of the epidemic:
The annual number of overdose deaths from prescription opioids nearly tripled from 1999 to 2011;
Prescriptions for opioid medications fell by 18 percent between 2012-2015;
From 2011-15, the annual number of deaths from prescription opioids remained relatively stable, but overdose deaths from illicit opioids nearly tripled;
As of 2015, 2 million Americans had an opiate-use disorder involving prescription opioids, with 600,000 involving heroin.
“This should be a wake-up call to health professionals, especially in living up to their responsibilities to do the right thing for consumers, who rely on doctors and others to be experts to determine what should and should not be done in terms of responsible pain management,” said Burnes Bolton, vice president of nursing, system chief nurse executive and chief nursing officer at Cedars-Sinai Health System in Los Angeles.
“The reduction in prescriptions we’ve seen is not nearly enough,” Hoffer said. “There are still many in the medical community who don’t understand how inherently dangerous these medications can be.”
While the report provides updates on pain treatment research and education, it also offers recommendations to health professionals, government agencies and others to help reduce the epidemic and, ultimately, save lives.
While doctors have a duty to treat acute and chronic pain—using opiates as one of the tools available—reducing abuse of the medications must be a key driver of future prescription practices that are responsible and restrictive, Hoffer said.
Even though a small percentage of patients prescribed opiates develop a substance use disorder—which drives a still smaller number to seek opiates on the illicit market—the level of legal prescriptions is so substantial that unprecedented numbers of people are now seeking heroin and fentanyl in response to addiction.
“It must be a better balancing act,” Hoffer said. “We don’t want to remove a legitimate treatment option. But, for instance, doctors need to be educated about evidence showing these drugs are most effective for treating short-term pain, but can be ineffective and harmful when used for long-term pain management.”
Among the committee’s recommendations:
Improve access to medications used to block the effects of opioids, such as Naloxone, and safe injection equipment;
Expand access and health-insurance coverage for treatment of opioid addiction;
Increase insurance coverage for current non-addictive pain treatment alternatives;
Invest in research to better understand the nature of pain;
Support the development of new non-addictive pain treatment alternatives;
Improve access to drug take-back programs;
Strengthen the post-approval oversight of opioid medications.
“We can’t give up on people with opiate use disorders. We hope this report is a piece of the puzzle to reduce an epidemic that has not even plateaued yet,” Hoffer said. “Frankly, it will take many years, earnest collaboration and much more money than has been dedicated to the crisis so far to see results.”
Members of the committee, known as the Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse, hailed from Yale University, Washington University in St. Louis, the University of Virginia and others.
The National Academy of Sciences, Engineering, and Medicine is a private, nongovernmental institution that offers guidance on issues related to science and technology.