WASHINGTON – Reducing prescribed pain medications and innovations in non-opioid treatments could help ease the opioid epidemic, according to top federal drug and public health officials.
Drug overdoses in the United States have nearly tripled over the last two decades. As a result, there has been a drop in life expectancy for the first time since the AIDS epidemic in 1993, Dr. Debra Houry, director of the National Center for Injury Prevention and Control at the Centers for Disease Control in Atlanta, told the Senate Health, Education, Labor and Pensions Committee last week.
While research continues on non-opioid alternatives for pain management, doctors play a key role in limiting the use of drugs whose deadly abuse is a national crisis, officials said.
“The key is to reduce the rate of overall exposure to help make sure that only properly indicated patients are being prescribed opioids,” Dr. Scott Gottlieb, commissioner of the Food and Drug Administration, based in Silver Spring, Maryland, told the panel.
“And when they receive a prescription, it’s for a duration of use that is as short as necessary to address their condition,” he added.
Officials said they were not minimizing the suffering of millions of Americans who need some sort of help relieving pain, but alternative treatment options and more judicious prescribing of is imperative to preventing addiction.
“CDC is focused on preventing people from getting addicted in the first place,” Houry said.
To do that, the CDC monitors opioid prescribing, tracks trends and champions community-based prevention activities, she said, adding her agency is funding prevention efforts in 45 states and the District of Columbia.
Houry said that the CDC is now releasing preliminary overdose data and has improved reporting significantly, giving states a better understanding of the changing epidemic so they can respond accordingly.
“The opioid crisis is tearing our communities apart, tearing families apart and posing an enormous challenge to health care providers and law enforcement officials,” said the committee’s chairman, Sen. Lamar Alexander, R-Tennessee. “The amount of opioids prescribed in the United States in 2015 was enough for every American to be medicated around the clock for three weeks, according to the Center for Disease Control and Prevention.”
Along with preventing exposure to opioids, agency officials said they will continue to work to improve treatments for people who are addicted.
“Addiction is a powerful force, driven by the powerful way in which opioids can literally rewire the brain,” Dr. Francis Collins, director of the National Institutes of Health, based in Bethesda, Maryland, told the committee. “When people suffering from addiction seek help, we owe it to them to provide treatments that will work for them. Research can help us get there.”
There are three FDA-approved medications for opioid use disorder, but Collins said relapse rates are too high and that more options are needed to end the epidemic.
“NIH has a successful record of partnering with industry to develop some of these new treatments and interventions,” Collins said.
Collins added that many communities have invested in Naloxone prevention kits which are meant to reverse an opioid overdose but he said that they are expensive and not every local law enforcement officer is comfortable administering an injection. NIH has developed a Naloxone nasal spray that is now the most widely used antidote, he said.
NIH will continue to partner with companies to explore ways to expand medication options to treat addiction and reverse overdoses, according to Collins. Another goal is to develop potent non-addictive medication for pain.
“The FDA strongly supports a transition from the current market, dominated by conventional opioids, to one where the majority of opioids have meaningful abuse deterrent properties,” Gottlieb said.
Medical devices that help to treat pain are also being developed and researched, he said.
Changing the stigma around addiction is the most important element in making sure people get the proper treatment, said Dr. Elinore F. McCance-Katz, assistant secretary for mental health and substance use at the Substance Abuse and Mental Health Services Administration, based in Rockville, Maryland.
“Addiction is not a crime, and so we have programs that we support throughout the nation that work towards establishing drug courts and ways to divert people away from the jail system to treatment,” McCance-Katz said.