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Policymakers need to look beyond just the recreational abuse of opioids in their efforts to reduce overdose deaths, and focus more on the problem of doctors who are overprescribing opioids as painkillers, said researchers at Brandeis University, the University of North Florida, and Johns Hopkins University.
There also needs to be greater access to opioid addiction treatments, they said.
“We need to prevent new cases of opioid addiction and we need to expand access to treatment for the millions of Americans who are already addicted,” says the study’s lead author, Dr. Andrew Kolodny, of the Heller School for Social Policy and Management at Brandeis University.
“Without better access to addiction treatment, overdose deaths will remain high and heroin will keep flooding in.”
In a new comprehensive study, scientists show that since 2002, new cases of non-medical abuse have gone down, and yet painkiller overdose deaths have soared. This is evidence, they say, that recreational use of painkillers is not a key driver of crisis.
The researchers suggest that policymakers need to focus on preventing new cases of opioid addiction caused by both medical and non-medical use and expanding access to opioid addiction treatment.
The researchers point to the soaring rates of opioid addiction as the explanation for high rates of overdose deaths and the rise of heroin use in non-urban communities. Since 1997, the number of Americans seeking treatment for addiction to painkillers has risen a whopping 900 percent.
The upward trend has been running alongside of the newer practice of prescribing long-term opioids for chronic pain, a practice encouraged by opioid manufacturers.
“I think we have overestimated the benefits of prescription opioids and underestimated their risks,” said study co-author Dr. Caleb Alexander, an associate professor of epidemiology at the Johns Hopkins’ Bloomberg School of Public Health and co-director of the Center for Drug Safety and Effectiveness.
“Although opioids have many risks, their addictive potential is of especially great concern.”
The scientists suggest that some of the same public health strategies used to control disease outbreaks can also be effective in bringing the opioid crisis under control.
Prevention strategies would include public education on the risks of prescription opioids, and wider use of state prescription drug monitoring program (PDMPs) data to alert prescribers to possible doctor-shopping by patients.
“By encouraging and, if necessary, requiring prescribers to use PDMPs, and by pro-actively sending them prescription data on their patients, states can help medical providers intervene at an early stage of addiction and get patients who need it into treatment,” said John Eadie, co-author and director of the PDMP Center of Excellence at Brandeis.
The researchers also suggest increasing access to the addiction medicine buprenorphine and ensuring that naloxone, an opioid overdose antidote, is available to emergency first responders, syringe exchange programs, and family members of people at risk for overdose. The authors assert that opioid addiction has long been overlooked as a key driver of the opioid epidemic, and a new approach is needed.
The paper is published in the journal Annual Review of Public Health.
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