Opioid Epidemic
Surgeon General Urges Many Americans to Carry Naloxone for Reversing Opioid Overdose
On April 5, U.S. Surgeon General Jerome Adams issued an advisory urging many Americans to carry naloxone, a life-saving drug that can reverse the effects of an opioid overdose. The medication is already routinely carried by many first responders, including emergency medical technicians and police officers. However, to help address the growing opioid epidemic, the Surgeon General is now recommending that more persons – including persons at risk for an opioid overdose, as well as their family and friends – also keep the drug on hand. “Each day we lose 115 Americans to an opioid overdose – that’s one person every 12.5 minutes,” noted Surgeon General Adams. “It is time to make sure more people have access to this lifesaving medication, because 77% of opioid overdose deaths occur outside of a medical setting and more than half occur at home . . . To manage opioid addiction and prevent future overdoses, increased naloxone availability must occur in conjunction with expanded access to evidence-based treatment for opioid use disorder.”
NIH Launches HEAL Initiative to Address Opioid Epidemic
This month, the National Institutes of Health (NIH) also rolled out the HEAL [Helping End Addiction Long-term] Initiative – which NIH describes as “an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis.” In particular, “This Initiative will build on extensive, well-established NIH research, including basic science of the complex neurological pathways involved in pain and addiction, implementation science to develop and test treatment models, and research to integrate behavioral interventions with Medication-Assisted Treatment for opioid use disorder.” Thanks to increased funding allocations from Congress, NIH is nearly doubling funding for research on opioid misuse/addiction and pain from approximately $600 million in fiscal year 2016 to $1.1 billion in fiscal year 2018.” The key objectives of HEAL are to prevent addiction through enhanced pain management, and improve treatments of opioid misuse disorder and addiction.
NIH research to enhance pain management will focus on:
- understanding the origins of chronic pain, by developing new tools and biomarkers to detect changes in the brain associated with acute and chronic pain, and then developing tools to control pain and restore function;
- developing new, effective, and non-addictive approaches for pain management; and
- enhancing clinical practice by defining and supporting best approaches for pain management.
Research to improve treatments for opioid misuse disorder and addiction will include:
- “precision prevention” techniques – strategies tailored to individual needs;
- new treatments for addiction, which NIH describes as “flexible and complementary treatment options for opioid use disorder to reduce drug use, prevent overdoses, and support recovery”;
- overdose prevention and reversal – developing new agents to prevent and reverse opioid overdose, including for potent drugs such as fentanyl and carfentanil;
- enhanced treatments for mothers with opioid use disorders and infants with neonatal opioid withdrawal syndrome; and
- optimized medication assisted treatments.
amfAR Recommends Strategy to Fight HIV, Hepatitis C, and the Opioid Epidemic
In its new 15-page report, Toward an Effective Strategy to Combat HIV, Hepatitis C and the Opioid Epidemic: Recommendations for Policy Makers, The Foundation for AIDS Research (amfAR) urges the adoption of a multifaceted strategy to increase access to treatment, reduce HIV and hepatitis C (HCV) infections, and lower the risk of fatal drug overdoses. The strategy recommendations include:
Increase Access to Treatment
- increase funding and reduce barriers to addiction treatment programs, including medication-assisted treatment;
- maintain insurance coverage for people with substance use disorders; and
- support research for new treatment options and overdose prevention.
Reduce HIV and HCV Infections
- lift the ban on the use of federal funding for syringes;
- develop state legislation authorizing the operation of syringe services programs (SSPs) and increase funding for SSPs;
- remove barriers to receiving treatment for HCV;
- maintain funding for services for people with HIV; and
- support surveillance for HCV, HIV, and other infections.
Prevent Drug Overdoses
- develop new funding streams to purchase naloxone and to make naloxone available to first responders and community members;
- enact naloxone access and Good Samaritan laws; and
- consider implementation of supervised consumptions sites.
The amfAR report concludes, “These recommendations provide a summary of federal and state actions that will be necessary to reduce drug-related deaths, reduce secondary infections like HIV and hepatitis C, and improve health outcomes for all people with substance use disorders. Ending the opioid epidemic is possible, but we must begin to act now.”
Impacts of Medicaid Expansion on the Opioid Epidemic
In related news, another recent amfAR study assessed the effects of Medicaid expansion on the U.S. opioid epidemic. In this study, amfAR researchers used Medicaid enrollment and reimbursement data from 2011 to 2016 in all states, and evaluated prescribing patterns of opioids and three Food and Drug Administration–approved medications used in treating opioid use disorders: buprenorphine, naltrexone, and methadone. Their analysis showed that per-enrollee rates of buprenorphine and naltrexone increased by more than 200% after states expanded Medicaid eligibility. In contrast, among the states that did not expand eligibility, prescribing rates increased by less than 50%. Prescriptions for methadone decreased in all states in this period, with larger decreases in expansion states.
According to amfAR, “the findings provide compelling evidence to refute claims made by some Members of Congress that Medicaid has fueled the opioid epidemic. The analysis also underscores that Medicaid is one of the most powerful tools in our arsenal to fight the opioid epidemic, and attempts to discredit its role in improving the lives of Americans living with substance use disorders are counterproductive and not supported by the best available evidence.”
Kaiser Brief Spotlights Key Points About the Intersecting HIV and Opioid Epidemics
The connections between HIV and the worsening U.S. opioid epidemic are also the focus of a recent graphically rich issue brief, HIV and the Opioid Epidemic: 5 Key Points, developed by the Kaiser Family Foundation. The key points, which are summarized in both text and graphic form are:
- The decline in HIV infections associated with injection drug use [IDU] has been a major success in the fight against HIV in the U.S., with the share of new HIV infections attributed to injection drug use falling from an estimated 40% in 1990 to just 6% in 2015.
- However, 2015 marked the first time in two decades where the number of HIV diagnoses attributed to IDU increased, largely associated with the opioid epidemic and subsequent HIV outbreak in Scott County, Indiana.
- The demographics of people with HIV attributed to injection drugs are increasingly similar to those most at risk for opioid use and addiction, with greater shares of those newly diagnosed being white and younger, relative to earlier years in the epidemic.
- While there are several proven strategies available to reduce risk of infectious disease associated with injection drug use, including the provision of Syringe Exchange Programs (SEPs), access varies significantly across the country and does not always align with opioid epidemic epicenters.
- While all Medicaid programs and some private plans cover Medication-Assisted Treatments (MATs) to address substance use problems, the AIDS Drug Assistance Program (ADAP) of the federal Ryan White HIV/AIDS Program offers an additional source of support for people with HIV with limited or no insurance coverage.
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