Possible Government's Action towards the Opioid Epidemic:
Knowing the statistics and where the government stands in the epidemic is useful in order to understand the importance and urgency of the matter. Every person that are in the politics, healthcare and law setting know that they should put a little effort in resolving the issue at hand. It is the only way to combat the epidemic. This is known by the example of Washington State. They made an effort to understand the gravity of the situation in their area since they know that states play a central role in protecting public health and public safety (Franklin 2015). The state has the responsibility of regulating, paying and managing health care. This is why they concluded that as a state, had a critical role in acting as the main way to reverse the prescription drug overdose epidemic.
To start, they made a study to understand the origins of the epidemic in their region, documenting a linear relationship between mortality and sales of a specific prescription opioids, by doing this they understood that the opioid prescribing practice was the main pathway of the epidemic. The first step in order to make an effort to recovery was to make an effective communication in the patient review and coordination program. Here, the goal was to provide the prescription history of the patient to prescribing providers, while identifying when risky behaviors occurred prior medical authorization. This programs was aided by a mental health treatment, and the results of participants where little but hopeful: a decrease of 33% in emergency departments visits and 37% in office visits; and 24% decrease in controlled substance prescriptions. This prompted the first guidelines of opioid dosing in which the stated the limits of morphine equivalent dosing about 120 milligrams per day (mg/d). The guideline had two parts: the first one being focused in naive patients which received a dose lower than 120 mg/d while the second one focused in patients already in in the stated limit dose.
After these guidelines, another were made by an emergency physician in which there was an encouragement to use an Emergency Department information exchange, where the departments could exchange information in real time. This came resourceful after a the bill passed in 2010, in which it was accomplished two key points: repealing the earlier permissive pain rules by the development of new rules had to address opioid dosing criteria, guidelines in pain specialty consultation, guidance in tracking clinical progress and adherent use of opioids. Some recommendations for the emergency departments were to limit the opioids prescription for chronic pain to a single provider; and discourage the administration of them intravenously and intramuscularly as relief for pain.
After these actions were taken, the state evaluated themselves and noticed improvements. They didn't stop with these actions, therefore they looked for improvement in order to achieve the best outcome possible. They gave free educational consultations as modeled by the University of New Mexico in which the consultations were given by a multidisciplinary group of pain experts and focused on management of chronic pain and addiction-dependence issues1. The guidelines once followed were edited to lower the morphine equivalent dose from 120 to 80 and 100 mg/d. This parametric were accepted by the practicing physicians since they were made from a collaboration of public agencies, clinical and academic pain leaders. Also, a law was passed in relation of naloxone, known as the Samaritan Law. This law gave legal immunity to people who had drug in their possession and were having an overdose from controlled substances, also to the people who had possession of said drugs but were looking for help for an overdosing patient are also granted immunity. The law also provided a naloxone prescription to anybody who would be at risk of overdosing or witnessing an overdose, therefore being capable of saving themselves or others.
Washington State is a very good example for the federal government to use as a model to respond the epidemic. Kolodny and Frieden (2017) made ten recommendations in which can and should be used as guidelines for federal and state level, since the only way to make front to the epidemic is to fight it all at once:
1. Improve surveillance of possible opioid addiction
2. Improve reporting of and response to opioid related overdoses and fatalities.
3. Promote more cautious prescribing for acute pain.
4. Change labeling for chronic pain and greatly restrict or eliminate marketing of opioids for this indication.
5. Increase insurance coverage of and access to nonopioid and nonpharmacological management of pain.
6. Interrupt the supply of heroin and illicitly produces synthetic opioids and improve coordination between legal and public health authorities.
7. Identify possible opioid addiction early and link individuals to treatment.
8. Expand low-threshold access to opioid agonist treatment, particularly with methadone and buprenorphine.
9. Implement harm reduction measures for current users, including access to clean syringes.
10. Consider removing ultra-high dosage unit opioid analgesics from the market.
As shown with Washington State, a key factor in the success of overcoming the epidemic is the effective communication between departments, councils and every person affected by the illness one way or another. There have been some states which declared emergency status, so, they could access some benefits that gives this status such as the facilitation of strategies to face the public health crisis. This can be the easier access for rural communities to medical personnel where the opioid-related deaths are higher per capita than those in urban areas.
Inside the effective communications can be stored some law changes in which normalizes and equilibrates the way that society faces said epidemic. Some new laws can change the barriers imposed by older laws in order to have a better outcome while facing the epidemic, like the ones that Washington State approved. Of course, there has to be taken in consideration factors of risks and possible outcomes for these laws and measure if the benefits are better than the liabilities.
Another way to face the epidemic is to check and improve the emergency response towards cases involving opioids through laws. The patient-prescriber surveillance, a reduced medical prescribing and the immediate availability of council for addicts are some ways in which lawmakers can diminish the actual addiction and prevent future people to suffer the illness. Other ways are the effective prosecution of drug dealers associated with these drugs primarily, also the prosecution of unethical physicians & pharmacists. A very important agency in this matter is the United States Customs and Border Protection (USCBP), who should be blocking entries of illegal opioids and tracking down the ways of entry of these types of drugs. It is not a secret that one main manufacturer is in China. Now, how do USCBP keep up with them in order to intercept the drug traffic is one big question with short possible answers.
The USCBP is not the only agency that has to make an effort, the Food and Drug Administration (FDA) and the National Institute of Health (NIH) are also agencies in which a big responsibility falls upon in order to combat the epidemic. Both of these agencies have on-going researches as the science field helps to look for short and long term solutions. Some of these projects are new formulations of exciting medications to bypass the limiting barriers that exist in present time. Making more accessible drugs such as better and longer lasting mu and kappa antagonists; developments of vaccines and manipulated formulations in order to make more difficult the illicit administration through snorting or injecting are some of the short term solutions that are evaluated towards the fighting of the epidemic. Nonetheless, long term solutions are focused in the development of new generation of non-addictive yet powerful opioids. Also in finding alternatives solutions to treat chronic pain such as treating pain with a mixture of morphine and an antagonist for the type 3 dopamine receptor or treating pain via the endocannabinoid system.
Another important aspect in how the government should respond in through the facilitation of education of this matter. The Center of Disease Control and Prevention (CDC) highlight the importance of physician and pharmacist education for this matter. These two figures are the first front since from them are the prescriptions taken and dispatched. Also educational consultations to people already ill helps them cope and understand what is going on through them. Keeping in mind illnesses associated with opioids, such as hepatitis C, and educating about them is also helpful since it keeps society at a constant reality check. Special classes, lectures and programs help society in general to understand the huge impact that it has in an ill person’s life.
The government has a lot of issues at hand, internally and externally. It is the control point for society to run its course. Maybe it's time to take the lead as a society and let the government follow and give the helping hand when needed. The only way to overcome this epidemic is when everybody works together without questioning.
References:
Franklin, G., Sabel, J., Jones, C. M., Mai, J., Baumgartner, C., Banta-Green, C. J.,Tauben, D. J., et.al. (2015). A Comprehensive Approach to Address the Prescription Opioid Epidemic in Washington State: Milestones and Lessons Learned. American Journal of Public Health, 105(3), 463-469. doi:10.2105/ajph.2014.302367
Gostin, L. O., Hodge, J. G., & Noe, S. A. (2017). Reframing the Opioid Epidemic as a National Emergency. Jama,318(16), 1539. doi:10.1001/jama.2017.13358
Kolodny, A., & Frieden, T. R. (2017). Ten Steps the Federal Government Should Take Now to Reverse the Opioid Addiction Epidemic. Jama,318(16), 1537. doi:10.1001/jama.2017.14567
Madras, B. K. (2017). The Surge of Opioid Use, Addiction, and Overdoses:Responsibility and Response of the US Health Care System. JAMA Psychiatry,74(5), 441. doi:10.1001/jamapsychiatry.2017.0163
Murthy, V. H. (2016). Ending the Opioid Epidemic — A Call to Action. New England Journal of Medicine, 375(25), 2413-2415. doi:10.1056/nejmp1612578
Volkow, N. D., & Collins, F. S. (2017). The Role of Science in Addressing the Opioid Crisis.New England Journal of Medicine,377(4), 391-394. doi:10.1056
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