Report Calls for Far-reaching Reforms to Stem Opioid Abuse

Megan Brooks

November 16, 2015

A report released today provides evidence-based recommendations for addressing the prescription opioid epidemic in the United States, including changing the way medical students and physicians are trained, the way prescriptions are dispensed and monitored, and the way in which first responders are equipped to treat overdoses.

"What's important about these recommendations is that they cover the entire supply chain, from training doctors to working with pharmacies and the pharmaceuticals themselves, as well as reducing demand by mobilizing communities and treating people addicted to opioids," Andrea Gielen, ScD, an author of the report and director of the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School of Public Health, in Baltimore, Maryland, said in a news release.

"The report is unique in terms of its breadth, as well as its rigor," G. Caleb Alexander, MD, an author of the report and codirector of the Johns Hopkins Center for Drug Safety and Effectiveness at the Bloomberg School, told Medscape Medical News.

"The report offers comprehensive and concrete recommendations grounded in the best available evidence for addressing the epidemic that were developed by a national group of experts representing a diverse group of disciplines and professional perspectives," he said.

The panel included professionals from the fields of medicine, pharmacy, injury prevention, and law, as well as patient representatives, insurers, and drug manufacturers.

In 2013, more than 16,000 people died in the United States from overdoses related to opioid pain relievers, four times the number who died in 1999, according to the US Centers for Disease Control and Prevention (CDC). Prescription opioid sales have increased 300% since 1999. The CDC estimates that 2 million Americans were dependent on opioid medications in 2013. The CDC estimates that in 2012, healthcare providers penned 259 million prescriptions for opioid pain relievers, enough to provide every adult in the United States a 4-week, 24-hour supply.

The report, The Prescription Opioid Epidemic: An Evidence-Based Approach, grew out of discussions that began last year at a town hall meeting cohosted by the Johns Hopkins Bloomberg School of Public Health and the Clinton Health Matters Initiative, an initiative of the Clinton Foundation. It provides guidance in seven categories:

  • Prescribing guidelines

  • Prescription drug monitoring programs

  • Pharmacy benefit managers and pharmacies

  • Engineering strategies (ie, packaging)

  • Overdose education and naloxone distribution programs

  • Addiction treatment

  • Community-based prevention strategies

The report calls for stricter oversight of clinical prescribing and more comprehensive training of medical students, who presently receive very little instruction on the subject. "We have to recognize that this isn't just a problem that begins in clinical practice. Prescribing guidelines and educating prescribers and future prescribers regarding best practices is vital," Dr Alexander told Medscape Medical News.

No Magic Bullets

The report recommends expanding the role of pharmacies and pharmacy benefits managers in reducing opioid misuse and abuse through increased use of electronic prescribing to identify high-risk patients and prescribers and through expanded availability of drug take-back programs.

The report also calls for mandatory use of prescription drug monitoring programs and recommends making them more accessible to law enforcement when warranted. Currently, these programs are voluntary in many states, and use varies, the report notes.

Further, the authors recommend developing more secure and tamper-resistant opioid drug packaging and expanding the availability of naloxone, which can reverse the effects of an overdose if administered promptly.

"There are no magic bullets when it comes to addressing this epidemic," Dr Alexander said, "and this report covers seven different areas that are all a piece of the puzzle and that together we believe can help to turn this steamship around.

"It will be important to work with policy makers at the federal, state, and local levels and clinician leaders of hospitals and health systems to implement these recommendations. We specifically avoided to many 'further research is needed' or 'more funding is needed' statements and tried to focus on what we can do today," Dr Alexander said.

The Prescription Opioid Epidemic: An Evidence-Based Approach. Published November 16, 2015. Full text

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