Attendees at the National Rx Drug Abuse & Heroin Summit in Atlanta this week looked to leaders for trends and solutions. Tom Frieden, MD, director of the Centers for Disease Control and Prevention (CDC), and Nora D. Volkow, MD, director of the National Institute on Drug Abuse (NIDA), presented up-to-date information on opioid misuse in the context of today’s healthcare system.
Frieden shared recent CDC data showing that death rates from overdose increased between 2010 and 2014 in all but two states. There has been a leveling off of deaths attributed to prescription opioids, but it’s combined with an increase in heroin and fentanyl overdose deaths, he said.
“There’s a blurring of the lines between prescription opioids and other opioids, but we know prescription opioids have become the gateway drug,” he said.
He noted recent programs that have improved outcomes, such as an Indiana initiative last year that responded to a sudden surge in cases of HIV and hepatitis C among those who were likely sharing needles.
“We took action, and knock on wood, we seem to have curtailed the outbreak,” he said. “We did things people don’t necessarily like to do: provision of syringe exchange, treatment [and] HIV treatment.”
Rep. Hal Rogers (R-Ky.) also presented the Rx Summit’s “Courageous Leadership Award” to Frieden for labeling prescription drug abuse as an epidemic several years ago. “That was a courageous move, one that intensified action from leaders across the country,” said Rogers.
How prescribing started the problem
The prescription opioid epidemic took the nation by surprise because it started with the healthcare system itself, said Volkow. In healthcare, “our aim is to help those who are suffering,” she said. “The last thing we want is to cause them another problem.”
But that’s what happened—undoubtedly as an unintended consequence. The Joint Commission labeled pain as a vital sign, encouraging healthcare systems to measure and relieve pain for patients. As a result, high rates of opioid prescribing led gradually to addiction and then to overdose, Volkow said.
“There was a lack of training in prescribing, and also a lack of recognition that substance use disorders are the responsibility of the healthcare system,” she said.
Naloxone is among the solutions
But there are solutions to the crisis, and naloxone is one of the most significant. Volkow got a rousing cheer from attendees when she advocated the availability of naloxone over-the-counter.
However, some critics believe that if naloxone is dispensed over-the-counter, there is less opportunity to drive people with SUD into treatment.
“My response is that they can’t get help if they are dead,” Volkow said. “People who are dying of opioid overdoses should not die. We have an antidote. We have tools. We need to implement them. And there is an urgency in doing so.”
In addition, access to treatment with methadone, buprenorphine, and naltrexone needs to be improved, she said.