The recent interim report from President Trump's Commission on Combating Drug Addiction and the Opioid Crisis addressed both the legal and illegal sides of the epidemic. Choking off the inflow of illegal drugs from Mexico and China through enhanced and coordinated law enforcement efforts is critical, as is dramatically expanding access to proven medication-assisted therapy for those addicted to illegal opioids or to legal prescription opioids.
However, bold actions recommended by the commission to eliminate overdoses from prescription opioids are equally important and highlight this under-reported aspect of the epidemic.
To start, it's important to have an accurate understanding of the crisis. Many people believe the problem relates exclusively to illegal opioids – mainly heroin and fentanyl. But there is much more to the epidemic than the illicit side.
An alarming number of opioid-related deaths are due to unintentional overdoses of prescribed opioids. In fact, 47 people die every day in the United States from prescription opioid overdoses, a threefold increase from 1999 to 2015. Regulations and laws to date have focused on restricting pain medications in terms of the annual amounts manufactured or limiting the total number of pills or days or maximum dose of a prescription. Unintended but unfortunate consequences of this approach have been that pain patients who legitimately need opioids suffer and those addicted to prescription opioids turn to far more dangerous heroin or fentanyl, fueling the soaring tide of illegal opioid overdose deaths.
The president's commission has focused on both accurately identifying the root causes of the epidemic and proposing a variety of strategies to limit the risks from prescription opioids.
Tragically, at least four of every five fatal prescription opioid overdoses are unintentional, a consequence that is particularly sad because these are preventable. The commission's recommendations begin with commonsense measures, such as increasing the training and continuing education of health-care professionals. Best practices related to prescribing opioids, treating pain, and early identification of those abusing or addicted to opioids must become more rigorously adopted.
Equally important, we must establish an effective nationwide network through which information about controlled substances legitimately prescribed and dispensed to patients can be shared for early identification of patients who may be misusing such medications. To date, every state but one has a state-run electronic prescription-drug monitoring database, which physicians are encouraged, but not required, to check before ordering an opioid or other controlled medication with abuse potential, such as Valium.
A recommendation posed to have a big impact on safety centers around changing existing patient privacy laws. Doing so would allow important risk factors for overdose or opioid use disorder (misuse or addiction) that are already in an individual's medical record to be easily but confidentially shared with other health-care professionals who may be prescribing medications.
The reasons are obvious. Many people treated with opioids have complex medical conditions that are managed by multiple health-care professionals at different facilities, each of whom could be prescribing different medications. An individual with certain health conditions can be more vulnerable to the dangerous sedating and respiratory-slowing effects of opioids. They also may be using other medications or substances that have similar effects. And a prescription opioid overdose is much more likely if they have a substance use disorder. All of a patient's health-care professionals need to have ready access to this information before they consider prescribing an opioid or other medications.
The commission also recommends making it easier to use all of the risk-factor information gathered from a patient's electronic health record and/or in a prescription-drug monitoring database to determine the patient's risk of having a serious opioid-related problem.
Software tools now exist that accurately can identify individuals or entire populations of patients that are at the highest risk for opioid overdose, abuse, or addiction. Given the limited time, money, and effort within an already stressed health-care system, such predictive analytical tools should be regarded as essential instruments that can be widely deployed to predict and prevent opioid overdose, addiction, and even death.
It is tragically ironic that prescription opioid overdose deaths have increased threefold to almost 50 per day in a time when we have all the data we need to effectively target at-risk patients and address their personal risk factors.
While there is still much work to be done to solve this crisis, it is encouraging that the president's commission is addressing many of its root causes. Employing the latest technology to help interdict the deadly influx of illegal drugs and predictive analytics to transform available patient risk-factor information into preventive actions are powerful weapons to combat the human toll of the ongoing national opioid epidemic.