Years of sustained and coordinated efforts will be required to contain and reverse the harmful societal effects of the prescription and illicit opioid epidemics, which are intertwined and getting worse, says a new report from the National Academies of Sciences, Engineering, and Medicine. The report, requested by the U.S. Food and Drug Administration (FDA), says it is possible to stem the still-escalating prevalence of opioid use disorder and other opioid-related harms without foreclosing access to opioids for patients suffering from pain whose providers have prescribed these drugs responsibly. The committee that conducted the study and wrote the report recommended actions the FDA, other federal agencies, state and local governments, and health-related organizations should take – which include promoting more judicious prescribing of opioids, expanding access to treatment for opioid use disorder, preventing more overdose deaths, weighing societal impacts in opioid-related regulatory decisions, and investing in research to better understand the nature of pain and develop non-addictive alternatives.
As of 2015, at least 2 million people in the United States have an opioid use disorder involving prescription opioids – meaning they are addicted to prescription opioids – and almost 600,000 have an opioid use disorder involving heroin. An average of about 90 Americans die every day from overdoses that involve an opioid. While the annual number of deaths from prescription opioids remained relatively stable between 2011 and 2015, overdose deaths from illicit opioids – including heroin and synthetic opioids such as fentanyl – nearly tripled during this time period, partially in connection to a growing number of people whose use began with prescription opioids. Drug overdose, driven primarily by opioids, is now the leading cause of unintentional injury deaths in the United States, and trends indicate that premature deaths associated with the use of opioids are likely to climb.
With this in mind, one approach to addressing the opioid epidemic is to have a fundamental shift in the nation’s approach to prescribing practices and improve awareness of the risks and benefits of opioids. To this end, the committee recommended enhancing education for both health professionals and the general public. Such education should involve mandating pain-related education for all health professionals who provide care to people with pain, requiring and providing basic training in the treatment of opioid use disorder for health care providers, and training prescribers and pharmacists to recognize and counsel patients who are at risk for opioid use disorder or overdose. In addition, the committee was struck by the relative lack of attention to educating the general public about the risks and benefits of prescription opioids and called for an evaluation of the impact and cost of an education program that raises awareness among patients with pain and the general public.