Implementing Effective Strategies to Address the Opioid Epidemic

The ongoing opioid epidemic is a complex, challenging, and severe public health crisis issue in the US and globally, which imposes significant health and economic burdens on the affected individual, family members, and the health care system. Health care providers across the country and globally, in conjunction with various national health care organizations, continue to expand efforts to identify and address the factors that contribute to the epidemic.

The CDC indicates that the number of individuals who died of a drug overdose in 2021 was over 6 times more compared to the number of affected individuals in 1999, and the mortality rates due to drug overdoses augmented by more than 16% from 2020 to 2021.¹ The CDC also indicates that more than 75% of the 107,000 drug overdose deaths in 2021 involved the use of an opioid.¹ Other vital statistics from 2020 to 2021 include:

• Mortality due to opioids increased by over 15%
• Mortality related to the use of prescription opioids stayed the same
• Mortality due to the use of heroin diminished by 32%
• Synthetic opioid-involved mortality rates (excluding methadone) soared by over 22%.¹

Despite dedicated efforts to combat the opioid epidemic, the problem remains, and various publications have attempted to explore the possible contributing factors and recommended strategies to alleviate the opioid epidemic. The causes of the ongoing opioid epidemic are multifaceted, and the US Department of Health and Human Services indicates that increased prescribing of opioid medications has resulted in the extensive misuse of both prescription and nonprescription opioids.²

A recent publication in NEJM 3 noted that opioids are frequently diverted and improperly used, and the extensive usage of opioids has contributed to the national epidemic of opioid overdose deaths and addictions.³

Another recent publication in The Lancet⁴ stated, “Although it is difficult to establish the major drivers of this crisis, experts point toward the influence by pharmaceutical companies, inadequate regulation, overprescribing by the medical profession, and increased use of illegal heroin and synthetic opioids.”⁴

In a recent publication in Molecular Psychiatry,⁵ authors indicated that successfully addressing the opioid crisis will necessitate basic science improvements, more effective treatments, and public health approaches to implement current and emerging knowledge, including effective preventative measures.⁵

In a recent publication in Cureus,⁶ authors conducted a survey and sought to investigate the views, experiences, and practices of prescribers and other healthcare personnel involved in the administration of opioids at an academic medical center. The survey involved 638 responses from 130 physicians, 44 residents and fellows, 53 physician assistants and nurse practitioners, 18 pharmacists, 85 medical students, and 308 nurses. The authors revealed, “Collected responses revealed a weak consensus on prescribing practices and a lack of evidence-based opioid management such as low utilization of multidisciplinary clinics and unfamiliarity with the WHO analgesic ladder across all specialties. The survey also indicated a lack of education regarding the prescribing of opioids across all specialties, although pharmacists reported obtaining the most education.” Based on the findings, the authors concluded that to address the ongoing opioid epidemic, there is a need to enhance communication and education initiatives about opioids as well as employ multidisciplinary measures, including recommendations from pain specialists. The authors also noted that pharmacists were more prone than other providers to report that prescribing habits have a "moderate" or "significant" part in the opioid epidemic.⁶

In an effort to promote safe and effective prescribing practices for pain management, in 2022, the CDC issued the CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022 Clinical Practice Guideline),⁷ which was developed as a voluntary guidance to assist prescribers with 12 recommendations for prescribing opioids for pain management including initiating opioid therapy, continuing therapy, recommendations for non-opioid pain management and preventing and treating opioid use disorder. Visit the CDC website for more information.

The CDC also provides several valuable resources regarding the use of evidence-based strategies to prevent opioid overdoses. More information can be found here.

On March 29, 2023, one of the most significant milestones in the fight against opioid overdosage was the FDA approval of Narcan, 4 milligrams (mg) naloxone hydrochloride nasal spray for over-the-counter (OTC) use as the first naloxone product approved for use without a prescription. In a press release, FDA Commissioner Robert M. Califf, MD stated, “The FDA remains committed to addressing the evolving complexities of the overdose crisis. As part of this work, the agency has used its regulatory authority to facilitate greater access to naloxone by encouraging the development of and approving an over-the-counter naloxone product to address the dire public health need. Today’s approval of OTC naloxone nasal spray will help improve access to naloxone, increase the number of locations where it’s available, and help reduce opioid overdose deaths throughout the country. We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price.”

Conclusion

There are continual efforts to address the ongoing opioid epidemic, and the most powerful tool in the fight against opioid abuse/misuse is educating both health care providers and laypersons about the crisis, the risk factors for opioid addiction, responsible prescribing habits, and about the various strategies recommended by pain management experts and different national health care organizations to prevent or reduce opioid addiction as well as the treatment of opioid use disorders. Due to their drug expertise, pharmacists can be instrumental in working with prescribers to ensure proper prescribing for opioids as recommended by the CDC, provide information about non-opioid analgesics, make clinical recommendations tailored to patient needs, educate patients about the safe and effective use of pain medications, and identify patients at risk for or exhibiting signs of addictions.

While the exact number is unknown, the CDC indicates that in 2020, on average, 44 people died each day from overdoses involving prescription opioids, and the number of individuals who die from opioid overdose and other drug overdosages continues to increase each day.⁸ While much has been accomplished in increasing awareness about opioid addiction and the ongoing epidemic, there is so much more that needs to be done to identify and address the factors that contribute to opioid addiction and the epidemic, and the first step involves preventing opioid addiction before it starts with routine patient monitoring, promoting effective patient education initiatives about the risk of addiction and using shared decision making about pain management including nonopioid analgesics when appropriate.

References

1. Centers for Disease Control. Understanding the epidemic | CDC’s response to the opioid overdose epidemic | CDC. www.cdc.gov. Published June 17, 2021. Accessed November 15, 2023. https://www.cdc.gov/opioids/basics/epidemic.html
2. Opioid Facts and Statistics. US. Department of Health and Human Services website. https://www.hhs.gov/opioids/statistics/index.html
3. Volkow N, McLellan T. Opioid abuse in chronic pain-misconceptions and mitigation strategies. N Engl J Med 374:1253-126. doi:10.1056/NEJMra1507771
4. The Lancet Regional Health-Americas. Opioid crisis: addiction, over prescription, and insufficient primary prevention. Lancet Reg Health Am. 2023 Jul 12;23:100557. doi:10.1016/j.lana.2023.100557
5. Volkow ND, Blanco C. The changing opioid crisis: development, challenges, and opportunities. Mol Psychiatry. 21(1):218-233. doi:10.1038/s41380-020-0661-4
6. Prempreet B, Brennan M, Grigoropoulos G, Hintz A, Parikh S, et al. Opioid knowledge, and prescribing habits at a large tertiary care academic center. Cureus. 22(8):e27843. doi:10.7759/cureus.27843
7. FDA Approves First Over-the-Counter Naloxone Nasal Spray. FDA.gov. March 29, 2023. Accessed November 8, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray
8. Prescription Opioid Overdose Death Maps. CDC website. June 2022. Accessed November 8, 2023. https://www.cdc.gov/drugoverdose/deaths/prescription/maps.html