HHS Official: ‘Fourth Wave’ Looms in Drug Crisis

Despite overall drug overdose-related deaths decreasing in 2018, other statistics indicate a rising “fourth wave” in the nation’s substance use disorder crisis means there is more work to be done, federal officials said in addresses presented during the evening plenary session of the virtual Rx Drug Abuse & Heroin Summit on Wednesday.

Admiral Brett Giroir, MD, assistant secretary of the U.S. Department of Health and Human Services, said methamphetamine-associated deaths saw a 20% to 30% year-over-year increase in 2018, with methamphetamine-associated deaths overtaking those linked to prescription opioids and heroin, with cocaine soon to be next. Polysubstance use is now the norm, Giroir said, noting that methamphetamine and illicit fentanyl or fentayl analogue use together is on the rise.

Deb Houry, MD, MPH, director of the CDC’s National Center for Injury Prevention and Control, noted that of the 47,000 opioid-involved overdose deaths in 2018, two-thirds involved synthetics, with increases observed across nearly all demographics.

Giroir said HHS’s approach to the substance use disorder crisis has been multifaceted and evidence-based, focusing on:

• Improving access to prevention, treatment and recovery support services
• Strengthening public health data collection and reporting to inform a real-time public health response as the epidemic evolves
• Advancing the practice of pain management to enable access to high-quality, evidence-based pain care that reduces the burden of pain for individuals, families and society.
• Targeting the availability and distribution of overdose reversing medications to ensure the broad provision of these drugs to those likely experience or respond to an overdose with a particular focus on targeting high-risk populations.
• Supporting cutting-edge research that advances our understanding of pain and addiction, leads to the development of new treatments and identifies effective public health interventions to reduce drug-related health harms

On the subject of expanding access to naloxone, FDA commissioner Stephen Hahn, MD, highlighted his agency’s work to broaden the overdose reversal medication’s availability. Most recently, FDA last month approved a generic, single-dose, prefilled syringe of naloxone, and the administration is supporting manufacturers who are interested in developing over-the-counter naloxone products, Hahn said.

In her portion of the program, Houry spotlighted CDC’s largest initiative to date: the Overdose Data to Action program, which is providing funding to 47 states, two territories, and 16 cities and counties to obtain comprehensive and timely data to inform prevention efforts.

She also highlighted a community program in Martinsburg, West Virginia, that is bringing together schools, police, public health officials, local universities and faith-based organizations to help at-risk children, and also said that CDC is soliciting input from a variety of stakeholders on the topic of expanding guidelines for prescribing opioids for chronic pain. Comments can be provided through the federal register or virtual meetings being set up with five cities.