What Can Be Done to Address the Opioid Epidemic?
When used correctly under a health care provider's direction, prescription pain medicines are helpful. However, misusing prescription opioids risks dependence and addiction.
Addressing overprescribing of pain medications through improved pain management and prescription monitoring has been one important prevention approach; and as illicit opioids like heroin and imported fentanyl become more prevalent, reducing the supply of those substances through law enforcement efforts is also crucial. But reducing the demand for opioids by addressing the reasons people turn to them and become addicted in the first place is just as vital and fundamental to ensuring that a new drug epidemic does not follow once the opioid crisis is contained. Two people talking with preventing drug use by addressing vulnerability factors that increase the risk for substance use disorders is an important component of the National Institutes of Health (NIH) HEAL (Helping to End Addiction Long-termSM) Initiative. Specifically, the HEALthy Brain and Child Development (HBCD) study being partially funded by HEAL will examine how the human brain develops in the transition from infancy into early adolescence. Evaluating the effects of fetal drug exposures, adverse environments, genetics, mental illness will provide knowledge to help us understand how these risk factors operate in conferring vulnerability for substance use disorders. Abundant research by NIDA-funded investigators over the past few decades has shown that positively altering a child’s life trajectory by reducing various risk factors, strengthening protective factors, and increasing access to resources can reduce or delay later drug use as well as minimize other adverse outcomes like criminality or other mental illness.
As seen throughout the history of medicine, science can be an important part of the solution in resolving such a public health crisis. In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive (Nora Volkow and Francis Collins, May 2017). Opioid overdose rates began to increase. In 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid. That same year, an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 652,000 suffered from a heroin use disorder (not mutually exclusive) (NIDA Notes).
Department of Health and Human Services, in concert with state organizations that administer prescription drug monitoring programs, should conduct or sponsor research on how data from these programs can best be leveraged for patient safety (e.g., data on drug–drug interactions), for surveillance of policy and other interventions focused on controlled substances (e.g., data on trends in opioid prescribing, effects of prescriber guidelines), for health service planning (e.g., data on discrepancies in dispensing of medications for treatment of opioid use disorder), and for use in clinical care (i.e., in clinical decision making and patient–provider communication).
As Opioid Use Disorders Increased, Prescriptions for Treatment Did Not Keep Pace (NIDA Notes, July 2018)
All Scientific Hands on Deck" to End the Opioid Crisis (Nora Volkow and Francis Collins, May 2017)
Using Science to Inform Practice and Policy: A Coordinated Approach to Research Priority Setting (Summary of December 11, 2017 meeting)