The federal government needs to meet an “urgent” need to provide more addiction treatment funding in communities, especially those which have been hardest hit by the opiate epidemic.
That is one of the recommendations in a new report from a group of experts, led by researchers at the Johns Hopkins Bloomberg School of Public Health in collaboration with the Clinton Foundation. The report, “The Opioid Epidemic: From Evidence to Impact,” maps out a blueprint for national action on the epidemic and details dozens of concrete, evidence-based steps for everyone working to fight the opioid crisis in America – from the health care, advocacy, nonprofit, government, academic, and business sectors.
The recommendations were developed by the Bloomberg School and the Clinton Health Matters Initiative with input from leaders in clinical care and pain treatment, pharmacy benefit managers, health policy and insurance, injury prevention and law enforcement, among others.
The report was prepared by researchers at the Bloomberg School’s Center for Drug Safety and Effectiveness and Center for Injury Research and Policy in collaboration with the Clinton Health Matters Initiative of the Clinton Foundation. The report includes an introduction by President Bill Clinton, founder and board chair of the Clinton Foundation.
“The nature of the epidemic has changed enormously during the past few years,” says G. Caleb Alexander, MD, co-director of the Center for Drug Safety and Effectiveness at the Bloomberg School and one of the report’s editors. “The opioid epidemic is a highly complex issue with an enormous human toll. But ultimately, the crisis can be stemmed with approaches that have been shown to be effective.”
The report’s other “priority” recommendations:
- Optimize prescription drug monitoring programs (PDMPs): PDMP utilization is associated with decreased opioid prescribing and adverse events, yet many states do not mandate PDMP registration and use.
- Work with medical boards to enact policies reflecting the CDC Opioid Prescribing Guideline: The Guideline, issued in 2016, remains the gold-standard for a comprehensive, evidence-based approach to prescribing opioids for chronic non-cancer pain in primary care, yet many organizations have not yet incorporated the guideline into practice.
- Support evaluation research of pharmacy benefit managers (PBMs) and pharmacy interventions: PBMs and pharmacies are engaged in many interventions to reduce opioid overuse and improve pain care, yet all too often these are not rigorously evaluated, leading to important knowledge gaps regarding what works.
- Secure funding to assess effectiveness of innovative packaging and designs: Data on the effectiveness of packaging interventions is limited. Evaluations of the available engineering innovations and those under development are needed to inform practice.
- Provide clear and consistent guidance on opioid disposal and expand “take back” programs: There are enormous volumes of unused opioids in homes throughout the U.S. that are too often diverted for non-medical use. Safe disposal options for prescription opioids are needed.
- Invest in surveillance of misuse and use disorders including information about supply sources: Surveillance of opioid use, misuse, and opioid-use disorders is critical for the improvement of primary, secondary, and tertiary prevention efforts.
- Partner with product developers to design easier-to-use and less costly naloxone formulations: Having multiple products that are easy for non-medical personnel to use would increase uptake and reduce costs. Price is consistently raised as a concern, and recent reports indicate that the cost of the drug is increasing dramatically.
- Establish and evaluate supervised consumption spaces: “Medically-supervised consumption of heroin in supervised consumption spaces may help prevent overdoses and can encourage users to get treatment.”
- Avoid stigmatizing language and include messages communicating effectiveness of treatment and acknowledgement of structural barriers to care: “Promoting language that does not stigmatize those with opioid use disorders can increase support for effective treatment of this condition.”
The report notes that prescription opioids serve a vital role in treating cancer pain and pain at the end of life. “A major challenge is to balance benefits with the potential harms of opioid medications, given the high potential for addiction, diversion, and overdose. Another challenge is that those already addicted need access to effective treatment without fear of stigmatization.”
“The opioid situation is certainly dire, but we are seeing progress in some areas,” says Shannon Frattaroli, PhD, associate director for outreach at the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School and one of the report’s editors.
In his introduction, Clinton pointed out that, “unlike with many diseases, we have the science and the experience to end the opioid epidemic.”