opioid addiction

In recent weeks, government officials from federal and state levels have once again called for renewed efforts aimed at tackling America’s opioid epidemic.

These measures range from limiting opioid prescriptions to getting more people into addiction treatment programs to investigating the role of pharmaceutical companies in fueling the crisis.

In 2015, opioids caused more than 33,000 deaths in the United States — a new record — according to the Centers for Disease Control and Prevention (CDC).

Prescription opioids — such as methadone, OxyContin, and Vicodin — accounted for almost half of opioid overdose deaths. The rest were due to other opioids such as heroin and synthetic fentanyl.

Will government efforts be enough to prevent more people from becoming addicted and help those who already have an opioid use disorder?

Read more: Opioid abuse and addiction »

Industry’s role in epidemic

Last month, Sen. Claire McCaskill (D-Missouri) requested internal documents from five top opioid manufacturers about their marketing tactics and what they knew about the possible risks of addiction and abuse related to opioid painkillers.

She is also seeking information on whether companies donated to groups that may have been working to block increased regulation of opioids.

“It’s time to look at the manufacturers and find out what they knew about addiction … [and] what marketing practices did they use to push these drugs,” McCaskill said in a conference call on Tuesday, as reported by USA Today. “We want to get to the bottom of why all of a sudden opioids have been handed out like candy in this country.”

The investigation currently focuses on five companies with the largest sales of opioids: Purdue Pharma, Janssen Pharmaceuticals, Insys Therapeutics, Mylan, and Depomed.

We want to get to the bottom of why all of a sudden opioids have been handed out like candy in this country.
Claire McCaskill, Missouri senator

In the past, Chicago and other localities have sued manufacturers over “deceptive marketing” of prescription drugs involved in the opioid epidemic — alleging these practices began as far back as the late 1990s.

Lawsuits accuse manufacturers of downplaying the addictive nature of opioids, leading to overprescribing of opioid pain medications.

Sen. Rob Portman (R-Ohio) also recently pushed for President Donald Trump to discuss with Chinese President, Xi Jinping, China’s role in manufacturing synthetic opioids like fentanyl.

These drugs are sometimes smuggled into the United States from Canada or Mexico, but they are increasingly shipped directly from China by mail.

Fentanyl is more potent than prescription pain medications and heroin. Over the past year, many states have seen a spike in fentanyl overdose deaths.

Read more: Opioids causing problems for chronic pain patients »

Tackling opioid overprescribing

Some states are trying to limit the availability of prescription opioids by enacting new opioid prescribing regulations.

In Ohio, a new rule limits acute pain prescriptions to no more than seven days of opioid pain medications — or five for minors. Currently, doctors can prescribe 30 to 90 days of opioids.

These types of restrictions straddle a line between preventing opioid abuse and tying a doctor’s hands when it comes to treating patients’ pain.

“I have a lot of concerns about inappropriate or overprescribing of opioids. However, I also have a lot of concerns about regulating medical practice, particularly at the level of how you manage the pain of a patient,” Dr. Itai Danovitch, chairman and associate professor in the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center, told Healthline.

I also have a lot of concerns about regulating medical practice.
Dr. Itai Danovitch, Cedars-Sinai Medical Center

The new Ohio rule will not apply to patients with cancer or those in palliative or hospice care or medication-assisted addiction treatment programs. These exemptions earned the approval of the Ohio State Medical Association.

States also use prescription monitoring programs to prevent patients from obtaining opioid pills from multiple doctors.

In Virginia, “physicians are required to log into a database to assess whether a patient has previously been prescribed opioids, to minimize the chances of so-called ‘doctor shopping,’” Kevin Doyle, EdD, LPC, LSATP, a professor in the Counselor Education program at Longwood University in Virginia, told Healthline.

These kinds of efforts “may help prevent the problem down the road, but there’s the issue of the people who are currently addicted and need treatment,” said Doyle.

Read more: Opioid ‘pill mill’ doctors prosecuted »

Trump commission to address opioids

President Trump is expected to sign an executive order setting up a commission to address the nation’s growing opioid epidemic.

The panel would identify federal funding that could be used to help people with opioid use disorder. Programs would include long-term support services and medical treatments.

Some have hailed the additional focus on the crisis.

“Trump’s commission is a good thing. It’s never a bad thing to really investigate an issue,” Deni Carise, PhD, chief clinical officer for Recovery Centers of America, told Healthline.

It’s never a bad thing to really investigate an issue.
Deni Carise, Recovery Centers for America

She also pointed out that U.S. Surgeon General, Dr. Vivek Murthy, released a report in November highlighting the country’s addiction crisis and steps to address it.

“There’s a lot of guidance that I think we can get from that document that’s already been made by a full commission of experts,” said Carise.

The American Medical Association, which focuses on raising awareness of the opioid crisis among physicians, applauded the creation of the new commission.

Some worry that budget cuts proposed by Trump to the Department of Health and Human Services and the National Institutes of Health (NIH) — along with a reorganization of the Centers for Disease Control and Prevention (CDC) — may work against the commission’s goals. These agencies fund treatment programs and research into improved treatments.

In addition, the Republican’s Affordable Care Act (ACA) replacement — had it passed — would have eliminated addiction treatment coverage for 1.3 million Americans on Medicaid.

This type of coverage was not always available.

The ACA, the Mental Health Parity and Addiction Equity Act, and other recent legislation required insurance companies to provide mental health coverage — including substance misuse treatment — similar to medical and surgical benefits.

“Those are really vital achievements that are absolutely critical to safeguard in the event that there are any changes to our healthcare system,” said Danovitch.

In spite of the improvements in mental health coverage, 89 percent of Americans who needed treatment for an illegal drug or alcohol problem did not receive treatment in the past year, according to 2013 federal data.

A recent study published by Danovitch and colleagues in the Journal of Psychoactive Drugs also found big differences in the quality of substance abuse benefits offered by California health insurance plans.

Getting more people into treatment means addressing many issues, including access to quality programs, affordability, and insurance coverage. This is especially true for certain segments of the population.

“What’s really been the tough area is your average American with basic health insurance being able to find a place that will take them and be able to bill their insurance for the majority of costs,” said Carise. “That’s the area where we really need to focus as a country.”

Read more: What’s the best way to treat opioid use disorder? »