New Technologies Can Help States Fight Opioid Abuse

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Drug overdose deaths have reached crisis levels in the United States. According to the National Vital Statistics System, 78 Americans die from an opioid drug overdose every day, more than any other cause of death. Prescription painkillers and heroin are the main drivers of this deadly epidemic, with certain areas of the Northeast, Midwest, and South suffering disproportionately.

Prescription painkiller abuse plays a serious role in the recent spike of overall drug abuse. Many who become addicted to opioids begin by taking prescription painkillers following a traumatic accident or surgery, or to aid in the day-to-day management of chronic pain. Somewhere in the process of managing pain the individual becomes addicted to opioids.

Pain management significantly impacts more than 100 million Americans, which not only increases costs to our health care and criminal justice systems, but is also a key contributor to lost workplace productivity. Rasor and Harris estimated that chronic pain is the second-leading cause of absenteeism from work, following the common cold. It has been estimated that long- and short-term chronic pain management costs the U.S. between $560 billion and $635 billion annually.

Ensuring pain sufferers have access to prescription pain medication while addressing the skyrocketing number of drug overdose deaths is a critical challenge for elected officials looking for ways to stop this public health epidemic. The American Legislative Exchange Council (ALEC) recently released Optimizing the Abuse-deterrent Opioids Market, a report detailing new medical technologies that aid in working with pain patients who may be at a higher risk for addiction. Abuse-deterrent opioids are pain medications that help treat pain while preventing abuse for those who are at a higher-risk for addictive behavior.

Abuse-deterrent formulations (ADFs) can work in different ways. Some ADFs are designed to neutralize the opioid’s extended release component that addicts often seek through tampering with pills. Other ADFs will release an unpleasant agent into the body when more pills are ingested than are medically necessary.

While these new technologies show promise of reducing the rate of addiction and drug-overdose deaths, they face regulatory hurdles in state legislatures and throughout the criminal justice system. Some disincentives include what is termed as the "fail first" approach, which is a rule that physicians are required to prescribe a non-abuse deterrent opioid before given the authority to prescribe an ADF. Other hurdles include third party payers authorizing pharmacists to substitute a generic, non-abuse-deterrent opioid despite the physician prescribing an ADF.

Doctors should be empowered to prescribe abuse-deterrent opioids when these medicines are appropriate. Tools such as a clinical questionnaire can be used to identify risk factors for potential opioid abuse and will help doctors determine when an abuse-deterrent or a non-abuse-deterrent opioid is appropriate for a patient. In such circumstances, the physician will retain full authority to prescribe an ADF, a decision that should be respected by third-party payers.

There have been some recent legislative successes in states experiencing a statistically significant increase in opioid abuse and drug overdose deaths. In March, West Virginia and Florida both passed legislation removing the "fail first" requirement from state statute. The Ohio Legislature is also currently considering such a measure. If passing these bills is successful, physicians will gain greater authority to prescribe what they see as the best treatment for the individual, specifically those who are at higher-risk for drug abuse than other patients.  

While pharmaceutical technologies such as abuse-deterrent opioids are only one approach to stopping the epidemic levels of drug overdose deaths, for some individuals, the use of these medicines could mean living both pain-free and spared from a life-long struggle with addiction.

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