COMMENTARY

Rx for Opioid Epidemic: Prevent, Rescue, Treat, and Hope

Rachel Levine, MD

Disclosures

May 17, 2017

Editorial Collaboration

Medscape &

Hello . I'm Dr Rachel Levine. I'm the physician general for the Commonwealth of Pennsylvania and a professor of pediatrics and psychiatry at the Penn State College of Medicine. I want to talk to you about the biggest health crisis that we have in Pennsylvania —you could argue, in the nation —and that is the opioid epidemic: prescription opioids, heroin, and overdoses.

Opioid Epidemic in Pennsylvania

The numbers are startling. In Pennsylvania in 2015, there were 3500 deaths due to overdoses; the numbers, we expect, will be worse for 2016.[1] There are more deaths from overdoses in the United States than from car accidents.[2] You can see the scope of this problem.

The origin of this problem goes back about 20 years when federal regulatory authorities asked physicians and medical providers to pay much more attention to acute and chronic pain. Pain became the fifth vital sign. At the same time, there was the expectation that not only would we be able to assess and treat pain, but somehow we were also going to eradicate it.[3] There was also the development of extremely powerful and long-acting pain medications that have proven to be very addictive to patients with acute and chronic pain. The third piece of the puzzle was the influx of cheap, powerful, and plentiful heroin from Central and South America. When you put all of these together, it exploded into the public health crisis that we see today.

To address this crisis, in Pennsylvania under the leadership of Governor Wolf, we're working on prevention, rescue, and treatment. We have networked with other states, as well as our federal partners, to that end.

Prevention Efforts

We're working with physicians and other healthcare providers on what I like to call "opioid stewardship." As we know, opioids are necessary medicines for some patients with severe acute and chronic pain. Just like antibiotic stewardship, we have to learn to use opioids more carefully and more judiciously. We're working with medical schools and professional societies for continuing medical education. We're working on voluntary prescribing guidelines and other actions to help physicians and other healthcare providers prescribe and dispense opioids carefully and judiciously.

Rescue Efforts

The second process we're working on is rescue, and that includes the medicine naloxone. Naloxone reverses an opioid overdose. In Pennsylvania, I signed two standing-order prescriptions for naloxone. One prescription was for first responders so that they have access to naloxone. In the last 2.5 years, police have saved 3000 lives with naloxone. The other prescription was for the public so that anyone in Pennsylvania can obtain naloxone. In other states, physicians are required to write prescriptions for patients who might be at risk for an overdose, who are on chronic opioids, or for families whose loved ones might suffer from the disease of addiction and could be at risk of overdosing.

Treatment Efforts

This brings up the very important point that addiction is a disease. It is a medical condition. It is a chronic relapsing brain disorder as outlined by the [now former] surgeon general of the United States in his recent pamphlet.[4,5] We need to get past the stigma associated with addiction. People tend to think that it is some sort of moral failing, but it is not. It is a disease like other diseases.

We are working to expand all types of treatment, and that can include drug-free or abstinence-based treatment. Substance Abuse and Mental Health Services Administration (SAMHSA) and other experts are recommending that we strongly consider increasing access to medication-assisted treatment. That includes methadone, buprenorphine compounds, and long-acting naltrexone. Medication-based treatment has to be combined with counseling and therapy. Remember, the medication assists the treatment. Just writing a prescription and then sending the patient out the door will not be successful. You have to engage the patient with counseling, therapy, and wraparound services. In addition to those services, medication-assisted treatment can be an extremely important tool to help patients with opioid use disorder.

I am a confident and optimistic person. I am confident that with all of us working together with health systems, the public, and the government, we will be able to give hope to our patients, their families, and our communities to overcome this horrible disorder.

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