The authors of an invited commentary published in JAMA Internal Medicine summarize a 5-point strategy that has been proposed for combatting the opioid crisis and the role they deem physicians should play in stemming the issue.
Curbing overdose deaths from prescription and illicit opioids in the United States requires a robust public health strategy and a committed response from healthcare practitioners. Prescribing practices are thought to have contributed to the addiction and overdose epidemic in the country, and therefore, modifying these practices may have a positive impact. Opioid overdoses have been shown to have a greater impact in white and lower-income areas. These disparities may reflect increased access to treatment combined with reduced treatment options in the more affected areas.
The US Department of Health and Human Services has proposed a 5-point strategy, with 72 focus areas, for stemming the opioid crisis by improving data, research, pain management, reversal drug targeting, and addiction treatment, prevention, and recovery services. In addition, the Centers for Disease Control and Prevention (CDC) have recommended, in their evidence-based chronic pain prescribing guidelines, increased use of prescription drug monitoring programs. A collaboration between the CDC and the National Institutes of Health on research focused on the prevention and treatment of opioid use disorder (OUD).
Despite a recent drop in opioid prescriptions, the current rate remains several times higher than it was at the end of the last century. In the past 2 years, a 19.4% decrease in morphine milligram equivalents prescribed, a 21% increase in buprenorphine usage, and a 368% rise in monthly naloxone prescriptions have been observed. Overall, opioid misuse among Americans appears to have significantly decreased.
Naloxone is considered a vital component in the fight against opioid overdoses, with the CDC recommending targeted prescribing and distribution to high-risk patients, as well as routine carrying by all first responders. Additional screening for OUD is also needed, with referral for medication-assisted treatment when necessary and/or utilization of alternative nonopioid pain therapies.
Clinicians can and should play an important role in catalyzing needed changes in the healthcare system. They can employ telemedicine to reach rural populations, facilitate electronic record enhancements to improve monitoring programs, offer more effective mental health and OUD therapies, and work with public health agencies to more closely track and understand abuse and overdose trends. Practitioners can also help mitigate stigma associated with opioid use and opioid use disorder, foster collaborations, and serve as experts in community efforts. However, getting past the complex opioid crisis will also require contributions beyond medical interventions, from local and national communities as well as from government agencies and workers.
“Only through awareness of how the epidemic is affecting various communities can we hope to solve this public health emergency. Clearly, evidence-based interventions must be targeted to the specific populations affected by the epidemic,” noted the authors.
Adams JM, Giroir BP. Opioid prescribing trends and the physician’s role in responding to the public health crisis. JAMA Intern Med. 2019;179:476-478.