While Congress disputes how to address the nation’s drug overdose epidemic, federal and state government officials are moving forward with new efforts to combat the problem.
The National Governor’s Association has begun work on a set of guidelines to reduce the overprescribing of opioid painkillers. Last month, the NGA, the National Association of Counties and other groups announced a plan to provide discounted overdose-combating drugs to public agencies.
Last October, President Obama directed agencies to pursue more training and treatment policies, announcing partnerships with more than 40 provider groups toward that end. This month, he asked Congress for $1.1 billion in new funding to address prescription opioid abuse and the heroin abuse to which it often leads.
And the Centers for Disease Control and Prevention is modifying new guidelines on prescribing painkillers, despite some delays in the process.
The efforts indicate an escalating focus among policymakers on the skyrocketing rate of prescription drug abuse in the U.S., a problem that has been building for more than a decade but only recently garnered major public attention. Drug poisoning deaths almost doubled between 2001-10, more often caused by opioid pain relievers than any other drug.
“I think there’s an increasing acknowledgment of the importance of addressing this issue,” said Aaron Gilson, a program manager at the World Health Organization Collaborating Center for Pain Policy at the University of Wisconsin.
But the difficulty in tackling the problem lies in its complexity. Doctors often don’t know whether to grant patients’ requests for pain medications, often erring on the side of overprescribing, and patients pass along extra pills to family and friends who then get hooked. And once people are addicted, there’s a shortage of treatment programs to help them break free.
There is wide, bipartisan agreement that prescription drug abuse is a problem that needs to be addressed, and soon. Several Democrats and Republicans have come together to propose bills responsive to the problem.
Yet familiar funding fights are threatening to tie up the first opioid-related bill with any momentum this year. Offered by Sens. Rob Portman, R-Ohio, and Sheldon Whitehouse, D-R.I., the measure would provide first responders with the overdose antidote Naloxone and support evidence-based treatment programs.
Democrats want to add $600 million to fund counselors and treatment programs, saying more money is needed to make the measure effective. Republicans, including Portman, are opposed. They say they could dip into existing pots of funding.
Meanwhile, the federal government and states are picking from a smorgasbord of approaches to reducing drug addiction and overdose. But since it’s a relatively new public health problem, experts are concerned that some of the efforts are a shot in the dark and warn that a variety of approaches is needed to figure out what works.
“It could be improved by having a more focused and targeted approach,” Gilson said. “Until we understand the issue more, we really can’t promulgate effective interventions.”
One new strategy is a change the Food and Drug Administration made in fall 2014 to how hydrocodone, a chief culprit among addictive pain relievers, can be prescribed. The agency reclassified it to a more restrictive status, limiting how much doctors can prescribe to a 30-day supply.
Whether the policy shift changes how often doctors prescribe the drug won’t be known for sure until the agency releases 2015 figures, probably near the end of this year. But a study published January in the American Medical Association’s Journal of Internal Medicine indicated a 22 percent decrease in the year after the reclassification took place.
Bob Twillman, executive director of the American Academy of Pain Management, says he was in favor of that policy change, but also worries about policymakers unintentionally creating a situation in which it’s too hard for patients who legitimately need pain relief to get it.
Policymakers, he said, often reach for “simple solutions” that could have unintended consequences.
“Really what we’re dealing with here are two interlocking problems that are very complex each in themselves,” Twillman said. “Substance abuse is a very complex problem, chronic pain is a very complex problem.”
Then there’s the question of how much to beef up law enforcement to deal with people who obtain and use drugs illegally versus how much to focus on treatment programs to help them once they’re addicted.
At a Senate Finance Committee hearing last Tuesday on the Portman/Whitehouse bill, Chairman Orrin Hatch, R-Utah, urged against taking an “overly simplistic view” of the problem. Ranking Member Ron Wyden, D-Ore., made a similar plea, saying the approach can’t be relegated to just enforcing laws or expanding treatment.
“My own view on what’s needed is a better approach that includes three things: more prevention, better treatment and tougher enforcement,” Wyden said. “True success will require all three to work in tandem.”
Some state governors are fixating on the problem, including Vermont Gov. Peter Shumlin and Kentucky Gov. Matt Bevin, who are leading the governors association’s efforts toward guidelines on opioid abuse prevention. The NGA’s health and human services committee has already approved a set of proposals from Shumlin, who has expanded access to addiction treatment across his state.
In a statement released jointly last week with the American Medical Association, the NGA advocated for a multi-pronged approach, including better doctor education about pain management, treatment for substance abuse and access to overdose-reversing drugs.
“Many states have already taken steps, and many physicians and medical societies have partnered in those efforts,” the statement said. “But collectively, we must do more … Not only is it our job, as governors and physicians, but also our responsibility to the American people.”
