How can we solve the opiate crisis? If you’re like most practitioners, you have thought about this problem and found very few helpful solutions. As the death toll rises, steps are being taken to prevent future patients from winding up addicted to opiates but how can we help those who are already taking them?
Right now, the President’s Commission is working with the FDA to promote development of abuse-deterrent opioids in order to address this pressing issue. The idea is to target common practices addicts and their use with these medications (such as snorting or injecting them) by creating pills with physical or chemical barriers to prevent such activities. Other formulations of these abuse-deterrent drugs incorporate an opioid blocker that can reduce the effect of the drug if too much is taken, or negate the effects entirely.
Creating drugs that are harder or impossible to abuse seems like a great idea to lawmakers, but in reality, they may not be the answer we’re looking for. They don’t actually eliminate the risks inherent in the drugs themselves, and may actually cause harm by misleading patients and lulling providers into a false sense of security.
Consider the fact that this current crisis started, in large part, because Purdue touted Oxycontin as a safe, non-addictive medication in the 90s. The FDA approved label on it read “Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.” which was very encouraging to doctors who wanted to help their patients manage pain. This led us down the path to Oxycontin being the most widely abused drug in the country, with addicted users finding ways to circumvent the supposed safeguards by crushing or dissolving the pills, leading to higher tolerance and more abuse.
There is not enough real-world evidence to support claims that abuse deterrent formulations can make enough difference to be worth the high cost. The tests conducted by the FDA take place in controlled environments without actual addictive behavior coming into play. The lack of ability to test these drugs in use by actual addicts makes it hard to justify a price-tag in excess of $200,000 to prevent one new case of opioid abuse. A study by the Institute for Clinical and Economic Review shows that, at current market prices, it would cost an additional $1.36 billion to prevent a single overdose death. The research and development money being funneled into these drugs could be better used for looking into treatment and coping strategies to assist those living with chronic pain and those already in the grips of addiction.
Another drawback of this approach is the paperwork. Prescribing these abuse-deterrent medications requires a lot of back and forth with insurance companies, who also balk at the high cost, so doctors spend time wrestling with red tape and bureaucracy that would be better spent with patients or their families.
There is no easy answer to the opiate epidemic, and thinking we can solve the problem with more drugs is short-sighted and could possibly backfire. As doctors, we need to take a more holistic approach to pain, be open minded about alternative therapies, and have honest conversations with our patients regarding the risks of all opiates, making sure they understand the pros and cons and have exhausted other avenues to deal with their pain. Spending money on public health campaigns to educate and empower the public with real knowledge regarding all the options for pain management could have a much greater and far-reaching effect than these costly specialized formulations of the drugs that got us here in the first place.
Emerald Coast Medical Association welcomes your input and feedback on this and other important issues facing doctors in Florida, the U.S.A. and around the world. We invite you to attend our monthly meetings, where you can share your opinions and thoughts with your peers.
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