A group of experts, led by researchers at the Johns Hopkins Bloomberg School of Public Health, are recommending several health care changes aimed at curbing the prescription opioid epidemic, a crisis that is killing an average of 44 people a day in the U.S.
The new recommendations were developed by professionals from medicine, pharmacy, injury prevention, and law with input from patient representatives, insurers, and drug manufacturers.
The report, calls for the following changes:
- how medical students and physicians are trained;
- how prescriptions are dispensed and monitored;
- how first responders are equipped to treat overdoses;
- and how those with addiction are identified and treated.
The report grew out of discussions that began last year at a town hall co-hosted by the Bloomberg School and the Clinton Health Matters Initiative, an initiative of the Clinton Foundation.
The call to action comes at a time of increased awareness about the prescription opioid crisis. More than 16,000 people died in the U.S. from overdoses related to opioid pain relievers in 2013, four times the number who died in 1999, according to the U.S. Centers for Disease Control and Prevention (CDC).
Prescription opioid sales have increased 300 percent since 1999. The CDC estimates that two million Americans were dependent on opioid medications in 2013.
“What’s important about these recommendations is that they cover the entire supply chain, from training doctors to working with pharmacies and the pharmaceuticals themselves, as well as reducing demand by mobilizing communities and treating people addicted to opioids,” says Andrea Gielen, Sc.D., director of the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School and one of the report’s signatories.
“Not only are the recommendations comprehensive, they were developed with input from a wide range of stakeholders, and wherever possible draw from evidence-based research.”
Until the late 1990s, prescription opioids were prescribed primarily to cancer patients. As new opioid drugs began coming onto the scene, they were aggressively promoted for wider use while their addictive potential was grossly underestimated.
According to the CDC, in 2012, health care providers wrote 259 million prescriptions for opioid pain relievers, enough to supply every adult in the U.S. a four-week, round-the-clock supply.
“This is a complex epidemic with no simple solutions,” says G. Caleb Alexander, M.D., M.S., co-director of the Johns Hopkins Center for Drug Safety and Effectiveness at the Bloomberg School and another of the report’s signatories.
“We tried to identify as many windows as possible, and to tie together as much research as available, to inform these recommendations which together we believe provide the best chance of turning this steamship around.”
Specifically, the report calls for stricter oversight of clinical prescribing and more comprehensive training of medical students, who presently receive very little instruction on the subject.
The experts also recommend expanding the role of pharmacies and Pharmacy Benefits Managers, both of which act as a medium between the prescribers and the patients who receive the medication. For example, increased use of electronic prescribing would identify high-risk patients and prescribers.
The authors also call for mandatory use of Prescription Drug Monitoring Programs (PDMPs). These are state databases that include controlled substance prescriptions from in-state pharmacies.
Currently, PDMPs are voluntary in many states and actual use varies; many prescribing providers are not even aware of them. The report also recommends making PDMPs more accessible to law enforcement when warranted.
The report calls for expanding the availability of naloxone, which can reverse the effects of an overdose if administered promptly. The experts also ask that more funding for treatment programs be given to communities with high rates of addiction.