The Opiod Crisis


By Donna Rogers, Editor

We all know there is an opioid crisis. The Centers for Disease Control estimates that 91 Americans die daily from opioid-involved deaths and a recent study by Dr. Christopher
Ruhm suggests that opioid-related deaths are severely underreported.  

On October 25 President Donald Trump signaled he might formally declare a national emergency over the opioid crisis in America later in the week, according to the news service UPI. The news outlet adds that some private industry stakeholders aren't waiting for government action. Retail chain CVS and the Cigna health insurance company are launching their own efforts to combat the epidemic. 

On October 16 the news program 60 Minutes in conjunction with the Washington Post aired an investigative report regarding drug industry efforts to lobby the Drug Enforcement Administration and Congress to weaken enforcement on opioid abuse. The investigation found that a bill pushed by the drug industry helped pump more painkillers into parts of the country that were already in the middle of the opioid crisis.  

The bill which relates to the necessity of distributors to report suspicious-seeming opioid orders, had originally been introduced in 2014, and the DEA got it killed; and in 2015, and the DEA got it killed again, explained Bill Hingham a reporter with the Washington Post during an interview with National Public Radio (NPR) after the 60 Minutes episode. Then there was a change in leadership. Says Hingham on NPR: “And there was also enormous amounts of pressure being placed on the DEA by Capitol Hill to pass this bill. And it was at the behest of the pharmaceutical industry. In fact, the bill was written by a pharmaceutical industry attorney who used to be a DEA attorney, one of—a senior DEA attorney.” 

The industry however is now making efforts to combat the problem on their own. CVS and the Cigna health insurance company are preparing to combat overdoses on potent opioid-based painkillers by restricting prescriptions of OxyContin. 

CVS plans to limit the size and dose of prescriptions, based on conversations with individual doctors to be sure patients receive what they need, the company told UPI. 

A formal declaration from the White House could spur funding for urgent treatment centers, closer work with healthcare providers to limit the spread of non-medical or overuse of opioid-based painkillers, and lower prices of overdose treatments like Naloxone. 

The problem is enormous. Overdose deaths from prescription opioids and the sales of prescription opioids have quadrupled since 1999, according to the CDC, with more than 180,000 deaths in the United States between 1999 and 2015 linked to prescription opioids. 

In March, Trump established a task force, the Commission on Combating Drug Addiction and the Opioid Crisis, headed by New Jersey Gov. Chris Christie. The panel has published recommendations for dealing with the crisis, though no government action had been taken as of late October. 


Multi-pronged approach 

The declaration by the government that the epidemic of drug use is a public health emergency should free up federal money and ease laws and regulations to address the crisis. 

Obviously it will take a multi-pronged approach to help those with addictions.  We know that nearly 150,000 people go through drug courts annually, according to the National Association of Drug Court Professionals. The opioid commission’s final report due to the president runs a gamut of prevention treatment and recovery, which delve into a full range of policy areas, according to sources familiar with the subject. It has three components: prevention, the increase of evidence-based treatment and helping those in recovery, stay in recovery. 


Medical-assisted Treatment 

One of the treatment methods is the use of medical-assisted therapy.  All the major national authorities endorse the use of meds to treat addictions. According to one of the drug companies, the National Institute on Drug Abuse (NIDA), the National Association of Drug Court Professionals (NADCP) and the Substance Abuse and Mental Health Services Administration (SAMHSA) recognize it as, if not the  most effective way to treat an addiction, a significant and effective component. 

Three medications are used to treat drug addictions—buprenorphine, methadone and naltrexone. All are FDA approved. All should be part of a comprehensive treatment plan. But it should be noted like any other medication, not every pharmaceutical preparation is effective for every individual, and every individual can experience side effects.  

In 2010 the U.S. Food and Drug Administration gave the go-ahead for the latest pharmaceutical, the once-monthly injection to treat opioid dependence. Vivitrol, a long-acting formulation of naltrexone had already approved as a monthly shot to treat alcohol dependence. The new indication put Vivitrol on a list of pharmacologic treatments for addiction—a list that already included methadone and buprenorphine. Vivitrol, unlike the original drugs— is considered an opioid antagonist or blocker, which blocks the opioid receptors. 

The issue is that judges, prosecutors and other criminal justice officials can be suspicious of the original FDA-approved addiction medications, buprenorphine and methadone, because they are themselves opioids.  

Vivitrol is a bit different, explains Jeff Harris, vice president, Policy and State Government Relations at Alkermes, its maker. It is considered an opioid antagonist or blocker, which blocks the opioid receptors. 

It requires the individual to stop taking opioids or alcohol and go through detoxification for a minimum of 7 days and as much as 7 to 14 days, he explains.  Therefore, the purpose of getting an injection is prevention after detox, either through a detox program in the court or with an incarcerated individual. they call the drug “nonaddictive.” Vivitrol can be provided as an inpatient or outpatient treatment for individuals in a range of criminal justice programs, details Harris. They can be in pretrial, diversionary programs, community corrections (probation or parole) or a reentry program with a risk for relapse, he points out. 

One of the biggest challenges in this crisis, says Harris, is that while a lot of treatment programs have adopted meds in their plan, it has been reported that only 10% of those who need specialty treatment are actually getting it.  

There are 3,000 drug courts across the country, continues Harris. Use of meds, including Vivitrol, is increasing incrementally, but there is “a lot of room for courts to adopt medications.” For instance, “only 15% nationally use Vivitrol.” 


An ‘Urgency’ To Solve It 

To attack this challenge head-on, resources, time and the effort of many health care and criminal justice professionals are needed. Unfortunately at present there is a fragmentation in the community to provide funding, coordination, etc., Harris acknowledges. Yet, finally we can sense some movement in the right direction. “We have an epidemic so there is an urgency to solve it. It takes effort, collaboration across a lot of different groups,” he concludes.  CT 


Editor’s note: As we went to press, President Trump declared the opioid crisis a public health emergency. 


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