Commission Addresses the Opioid Crisis in North America

The Stanford-Lancet Commission released recommendations, published in The Lancet, about responding to the opioid crisis in North America.

In the mid-1990s, insufficient regulations of the pharmaceutical and healthcare industries allowed for-profit entities to quadruple opioid prescribing in North America. At this time, opioids began to be prescribed for a broad range of chronic, noncancer pain conditions which departed from long-established practice norms.

As a result, hundreds of thousands of North Americans had fatal overdoses and millions more became addicted. In addition, the heroin market became resurgent as demand for opioids increased.

In 2020, fatal opioid overdoses reached an all-time yearly high of >70,000 in the United States and >6,300 in Canada. These deaths are most common among men and young to middle-aged populations and has increasingly affected populations of Color.

The Commission has released 7 domains about the cause, effects, and recommendations to address the opioid crisis.

The Commission concluded that the crisis was caused by weak laws and regulations such as failures by the US Food and Drug Administration (FDA). The FDA approved labeling which falsely claimed that the long-acting opioid OxyContin® (oxycodone hydrocholoride) was less addictive than other opioids. During this period, opioid manufacturers were able to foster intimate relationships with universities, advocacy groups, and lawmakers allowing for aggressive product promotion. In order to avoid similar situations in the future, there should be sufficient insulation between education and policy from the pharmaceutical industry and limitations on corporate donations to political campaigns should be restored in the United States.

Another area to address is the lack of high-quality, accessible, nonstigmatized health and social services for individuals with opioid use disorder (OUD). This can be achieved with increased funding and to promote chronic-disease management models.

Although controversial, the Commission advocates for the criminal justice system to play a role in the opioid crisis recovery. This could be accomplished by increasing access to addiction treatment and other health services during incarceration. Furthermore, individuals possessing illicit opioids for personal use should not necessarily be incarcerated and laws for collateral penalties for drug-related crimes and opioid use during pregnancy should be repealed.

The Commission in general stated that the response across society as a whole has been too slow. There should be an emphasis placed on developing nonopioid medications, redesigning of the opioid molecule, and innovative strategies for disrupting the fentanyl market.

For the future, the Commission is warry of the current trend of pharmaceutical companies based in the United States, which are expanding opioid prescribing worldwide. Companies should be banned from exporting aggressive opioid-promotion practices to low-income countries, such that a similar situation which unfolded with tobacco companies targeting poorer nations is not repeated with opioid manufacturers.

The opioid crisis has been developing over decades and will undoubtedly take time to reverse. It is imperative that problem areas be addressed promptly so that lives are saved and suffering is reduced in North America and worldwide.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Humphreys K, Shover CL, Andrews CM, et al. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford–Lancet Commission. Lancet. Published online February 2, 2022. doi:10.1016/S0140-6736(21)02252-2