Creating Effective Policy in Response to the Opioid Epidemic

Most people who either read articles or watch TV news, know that we are going through a continued opioid use epidemic in the United States. What many of these people should also know is that this epidemic began with physicians prescribing significant amounts of opioids to treat pain and lost track of what was happening to the patient. During this time, a number of the individuals who were using prescription opioids began to inject them. Some of these patients transitioned to using heroin. In many cases, this would then lead into using fentanyl.

The increasing availability of fentanyl has taken many policymakers by surprise. It is frequently indicated that fentanyl is 50 times more powerful than morphine, making it an incredibly addictive drug. This is what has caused so many fatalities when a powerful opiate is combined with powerful stimulant like methamphetamine. While we have several treatments for opioid use disorder (methadone, buprenorphine, naltrexone), there are no reliable medical treatment interventions for stimulant use.

Federal Policy and Legislation Responding to Opioid Epidemic

There are a number of federal regulatory policy changes in addition to Congressional legislation aimed at responding to increasing reports of opioid related overdose deaths, primarily driven by fentanyl/methamphetamine use. Some of the legislation, as proposed by US Reps Donald Norcross, Paul Tonko, and Lori Trahan, is certainly breaking new ground.

Some of the legislation conflicts. Illustratively, Tonko wants to eliminate the 8-hour medical training requirements for practitioners who want to prescribe buprenorphine to treat opioid use disorder. Trahan wants to increase training for all medical practitioners who are prescribing opioids to treat either pain or opioid use disorder. Many of the providers in the opioid treatment sector think that Trahan’s legislation is more practical. Tonko’s legislation does not take into account the shifting patterns of how more powerful opioids like fentanyl are being used more widely, which makes such patients more complex to treat. Norcross’s legislation has some favorable elements of moving the system forward with new approaches to increase access to care for opioid treatment programs.

On the other hand, a section of his legislation proposes to provide physicians with prescriptive authority for methadone hydrochloride products for the treatment of opioid use disorder without any specialized training, especially geared to treating opioid use disorder. 

Expanding in Correctional Facilities

There are many great opportunities for treating people with opioid use disorder in prisons and jails. There is the beginning of a broader movement to increase access to such opioid-using inmates so that they can be treated during their incarceration and then referred to treatment in a “warm-handoff.” As an example, the New York state legislature recently passed legislation that would require all correctional facilities in the state to treat inmates with opioid use disorder, using the 3 federally approved medications. This must be done by October, which involves cooperative working relationships between treatment providers and the justice system. It is landmark legislation, and it is understood that other states will follow suit.

Expanding Access to Effective Treatment

It is also important to point out that federal agencies such as the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) are making great strides to increase access to good quality care. Illustratively, the DEA released regulations during June 2021 that will have mobile vans working in conjunction with outpatient opioid treatment programs (OTPs) to reach people who cannot easily get into the OTP central hub site. Recently, New York state and New Jersey provided funding so that such programs can open and treat people in need of such care. Additionally, SAMHSA is making it easier for OTPs to work with satellite medication units, which will be the spokes to the OTP hub site. Once again, the implementation of such new treatment opportunities is complicated, but we are at a very favorable starting point.

Educating the American Public

There is a need for a national public health education campaign before treatment can be expanded in rural and other underserved areas of the country. The American public needs to better understand how individuals who use opioids can easily get into trouble if they begin to misuse their medication and do not follow the explicit directions that the pharmacy has labeled on the bottle. There also needs to be a second part of this national education campaign to explain how effective the 3 federally approved medications are in treating this disorder. It is important to note that this illness is not some kind of moral weakness on the part of the individual who gets into trouble using these drugs. The ongoing use of opioids affect the brain, which causes dependence and addiction, which is now termed as opioid use disorder.

Without any question, the opioid use epidemic will continue to evolve and policymakers, in addition to legislators, need to be mindful of the consequences of their recommendations. The idea is to increase access to effective treatment for opioid use disorder to improve the lives of people who need help.

Mark W. Parrino, MPA, is president of the American Association for the Treatment of Opioid Dependence (AATOD).

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Addiction Professional, Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.