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On October 26, 2017, President Donald J.Trump declared the opioid epidemic a national public health emergency.1 “The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. If they don’t start, they won’t have a problem,” he stated. The President had announced last August that the government’s response to the opioid epidemic would be the object of a national vs public health emergency. Such a status would have warranted a faster and greater allocation of dedicated funds.
The White House press release states: “President Donald J. Trump is mobilizing his entire Administration to address drug addiction and opioid abuse by directing the declaration of a Nationwide Public Health Emergency to address the opioids crisis.” Actions under this mandate include expansion of access to telemedicine services, including remote drug prescribing, and improved access to addiction specialists and to substance abuse treatments for patients with HIV. The President’s Commission on Combating Drug Addiction and the Opioid Crisis was established in March 2017 with the mission “to study the scope and effectiveness of the Federal response to drug addiction and the opioid crisis and to make recommendations to the President for improving that response.”2 This Commission is expected to issue a report with recommendations to guide the administration on a set of measures that will most adequately address the crisis.
Clinical Pain Advisor sought the feedback of 2 pain specialists and advisory board members, Beth Darnall, PhD, and David Rosenblum, MD, on how such a move by the administration is likely to benefit individuals with an opioid addiction and prevent others from getting addicted, as well as what may have been omitted from it.
Clinical Pain Advisor: What is your take on the White House’s declaration?
Dr Rosenblum: The White House’s response is commendable, but it may be too little, too late. The patients are already addicted [to opioids] and many of them may not want to be rehabilitated.
The government should share the blame along with the pharmaceutical industry, physicians, and those patients who play on a clinician’s sympathies to obtain opiates. The pressure that physicians had to face when pain was not treated, and the fact that pharmaceutical companies were given the green light to market the way that they did contributed to the current situation.
Clinical Pain Advisor: How may cuts to the Affordable Care Act (ACA) affect efforts by the White House to address the opioid crisis?
Dr Darnall: The Opioid Emergency declaration is a great first step. Now, we need resource allocation to address the problem and connect individuals to needed treatment. Federal cuts to healthcare that limit access to addiction and mental health treatment will undermine goals and will only facilitate this growing national healthcare problem.
Clinical Pain Advisor: How would funds best be allocated?
Dr Darnall: Primarily, access to addiction treatment and mental health care are desperately needed to address the opioid crisis. We have excellent addiction policy experts in the United States who could greatly expand on specifics needed to tackle this problem. Among the issues are improved access to life-saving drugs to treat opioid overdose and addiction treatment.
The issue of needing to treat pain better must be addressed. To properly address the problem, federal funds are needed in 2 areas: clinician training and policy changes that improve access to treatment. Fundamentally, patients with pain need access to nonpharmacologic and nonopioid treatment strategies, such as behavioral treatments (psychological and self-management modalities) and physical therapy. We need to scale these evidence-based treatments to meet the needs of the 100 million Americans living with ongoing pain and doing so requires funding to train more psychologists, physicians, and physical therapists to become chronic pain experts.
The solution to treating pain with lowest-risk strategies requires education and training across all key stakeholder groups: physicians, patients, and all healthcare professionals. The National Pain Strategy and the Federal Pain Strategy nicely outlined the goals for best pain treatment in the United States. Now, we need a major federal investment to implement those recommendations nationally.
Dr Rosenblum: I feel the funds would be best allocated to educate children about the epidemic. Opiate-sparing pain management and interventional pain management should be better funded by the government as well as commercial payers. For example, when I prescribe Butrans®, the insurer often asks me to use a cheaper formulary drug such as hydromorphone or morphine. This is not in the patient’s best interest.
Dr Darnall is clinical professor in the division of pain medicine at Stanford University School of Medicine in California. Dr Rosenblum is director of pain medicine at Maimonides Medical Center in New York City.
References
- The White House Office of the Press Secretary. President Donald J. Trump is taking action on drug addiction and the opioid crisis. Available at: https://www.whitehouse.gov/the-press-office/2017/10/26/president-donald-j-trump-taking-action-drug-addiction-and-opioid-crisis. Accessed: October 27, 2017.
- The White House Office of National Drug Control Policy. President’s Commission on Combating Drug Addiction and the Opioid Crisis. Available at: https://www.whitehouse.gov/ondcp/presidents-commission. Accessed: October 27, 2017.
