In this month’s Rosenthal Report, we examine a record decline in opioid prescriptions and an increase in the use of addiction medications, and explain what this means in the fight against the opioid epidemic. In news briefs: Rhode Island reduces overdose deaths among recently released prisoners; and politicians recalibrate their positions on marijuana legalization.
Policies on Opioid Prescribing and Addiction Medications Yield Promising Results, But Must be Part of a Comprehensive Strategy
Efforts to limit the volume of opioid prescriptions and increase the use of addiction treatment medications are having an impact. According to newly released data, the volume of clinically prescribed opioids declined 10 percent in 2017. This was the steepest fall in 25 years, and included a16.1 percent reduction in high-dose prescriptions. Meanwhile, new monthly prescriptions for three FDA-approved addiction drugs that relieve withdrawal symptoms and drug cravings - methadone, naltrexone and buprenorphine – nearly doubled to 82,000 over the past two years.
The new data illustrates the effectiveness of two critical strategies: more aggressive monitoring mechanisms and stricter clinical guidelines to limit opioid prescriptions, and expanded access to medication-assisted treatment (MAT) programs that combine appropriate addiction medications with counseling and behavioral therapy.
These results are encouraging, but must be considered in the broader context of a deeply entrenched national epidemic. For example, the nation’s death toll from the drug crisis continues to rise. While 15 states lowered their rate of overdose fatalities, there were double-digit spikes in the other 35. This was largely due to the influx of the powerful synthetic opioid fentanyl, which is mixed with other drugs and is now the leading cause of overdose deaths, outpacing for the first time prescription opioids.
Any reduction in opioid prescriptions, which peaked in 2011, is welcome. Yet even with the latest decline opioids are still massively overprescribed. As the New York Times pointed out, the nation’s annual level of morphine prescriptions now totals 171 billion milligrams - enough for every American adult to have 52 pills. After clawing our back to 2006 prescribing levels, we must continue to reduce the availability of prescription painkillers while ensuring that those with legitimate needs for these drugs have access to their medications.
Expanding treatment and getting more addicts who need it into MAT programs is critical to slowing the epidemic. However, the latest data does not indicate how many new addiction medication prescriptions are filled for MAT patients who are not receiving concurrent therapy. This would be simply swapping one drug for another without providing support for life change. There are also significant gaps in access to addiction medications: an estimated 60 percent of rural counties do not have one doctor authorized to prescribe buprenorphine, which requires a waiver from the Drug Enforcement Agency.
We are making strides to bring the opioid crisis under control. But success depends on accelerating the pace by implementing comprehensive, coordinated, and well-funded strategies. Last month, Senator Elizabeth Warren of Massachusetts and Rep. Elijah Cummings of Maryland introduced a bill calling for $100 billion in funding over the next decade to address the opioid epidemic. Modeled on successful HIV/AIDS legislation, the bill is a major funding boost from Congress’s current $6 billion annual budget proposal. With nearly 64,000 Americans dead in 2016 from drug overdoses, $200 billion would be a more appropriate commitment.
SMALL STATE, BIG RESULTS: Rhode Island slashed the overdose mortality rate among recently released prisoners by 61 percent, according to a study in JAMA Psychiatry. Credit goes to a new program offering all inmates screening and MAT treatment while in jails and prisons as well as at outpatient facilities post-incarceration, when, as the study noted, they are more likely to relapse.
SWITCHING SIDES: Former Republican House Speaker John Boehner, once a staunch opponent of marijuana legalization, has joined the advisory board of Acreage Holdings, a company that cultivates, processes and sells cannabis in 11 U.S. states. Explaining his new position, Boehner said his thinking had “evolved” after studying the criminal justice system and the needs of veterans to access the drug legally for disorders such as PTSD. Boehner joins the legalization bandwagon at a time when politicians from both parties are assessing voter sentiment on pot and recalibrating their positions accordingly, including New York Senator Chuck Schumer who now favors federal decriminalization of marijuana. Meanwhile, New York Governor Andrew Cuomo faces a spirited challenge for the gubernatorial nomination from actor Cynthia Nixon, who has made legalizing recreational pot a centerpiece of her campaign against the incumbent.