When correctly used, opioid analgesics such as hydrocodone, oxycodone, codeine, morphine and methadone can be effective options to treat acute and chronic pain. But during the past decade, this class of drugs has increasingly been implicated in drug overdose deaths.
Given this trend, HHS Secretary Sylvia Burwell announced a targeted initiative(aspe.hhs.gov) on March 26 that aims to reduce prescription opioid- and heroin-related overdose, death and dependence.
The president's FY 2016 budget request includes $133 million in new funding to address this critical issue, according to an HHS news release.(www.hhs.gov)
The HHS effort focuses on three priority areas:
- Providing training and educational resources, including updated prescriber guidelines, to assist health professionals in making informed prescribing decisions.
- Increasing use of naloxone, as well as continuing to support the development and distribution of the drug, to help reduce the number of deaths associated with prescription opioid and heroin overdose.
- Expanding the use of medication-assisted treatment (MAT), which combines the use of medication with counseling and behavioral therapies to treat substance use disorders.
- HHS Secretary Sylvia Burwell announced a targeted initiative on March 26 that aims to reduce prescription opioid- and heroin-related overdose, death and dependence.
- The effort focuses on three priority areas: providing training/educational resources to assist in prescribing decisions, increasing use of naloxone and expanding the use of medication-assisted treatment.
- On March 6, the CDC launched the Prescription Drug Overdose Prevention for States program to provide state health departments with resources to enhance their prescription drug monitoring programs.
"Opioid drug abuse is a devastating epidemic facing our nation," Burwell said in the news release. "I have seen firsthand in my home state of West Virginia, a state struggling with this very real crisis, the impact of opioid addiction. That's why I'm taking a targeted approach to tackling this issue focused on prevention, treatment and intervention.
"I also know we can't do this alone. We need all stakeholders to come together to fight the opioid epidemic."
FP Expert Explains Plan's Priority Areas
The three priority areas build on current HHS strategies to address the opioid epidemic and expand on the initiatives that have the greatest potential for impact, according to the release.
Robert Rich, M.D., who chaired the AAFP opioid and pain management workgroup for the Academy's Commission on Health of the Public and Science, told AAFP News he hopes the overarching initiative will translate to more funding for opioid educational efforts, including those that address safe opioid prescribing; expansion of treatment programs for patients with opioid and heroin addiction; and further research into acute and chronic pain management.
HHS said it will address the first priority area of helping health care professionals make informed prescribing decisions by:
- working with lawmakers on bipartisan legislation that would require specific training for safe opioid prescribing, as well as seeking to establish new opioid prescribing guidelines for chronic pain;
- supporting data-sharing by facilitating prescription drug monitoring programs (PDMPs) and health IT integration, along with promoting further adoption of electronic prescribing practices; and
- increasing investments in state-level prevention interventions, including PDMPs, to track opioid prescribing and support appropriate pain management.
Rich said he hopes funding in this area will be used to finance education that will describe the tools used to promote safe prescribing.
"Several of the opioid educational efforts have been devoted to the techniques of safe opioid prescribing, and those efforts could be expanded and further publicized," he said. "Most of these efforts contain tools such as pain contracts, consent forms, screening tools for underlying behavioral health or substance abuse issues, which need to be pulled out by family physicians and adopted for use in their individual offices."
It should be noted that although the AAFP has for years acknowledged the public health threat posed by misuse and abuse of prescription drugs, especially opioid analgesics, such concerns must be balanced with patients' legitimate need for appropriate pain management. Thus, the Academy long ago went on record as opposing any type of mandatory education as a prerequisite to DEA registration or licensure to prescribe opioids.
In fact, according to a position paper(15 page PDF) released in August 2012, "the AAFP opposes any action that limits patients' access to physician-prescribed pharmaceuticals, and opposes any actions by pharmaceutical companies, public or private health insurers, legislation, the FDA or any other agency, which may have the effect of limiting by specialty the use of any pharmaceutical product."
Regarding the HHS plan's second priority area, the agency intends to increase use of naloxone by:
- supporting the development, review and approval of new naloxone products and delivery options,
- promoting state use of Substance Abuse Block Grant funds to purchase naloxone and
- implementing the CDC's Prescription Drug Overdose Prevention For States(www.cdc.gov) grants program for states to purchase naloxone and train first responders on its use.
Rich said naloxone is the narcotic antidote used most commonly to resuscitate victims of opioid overdose, and many states have begun efforts to improve the availability of naloxone to first responders such as law enforcement and emergency medical services personnel.
"Several states have even passed laws promoting the availability of bystander naloxone to the lay public, which has been shown to further extend the availability of this lifesaving medication," he said. "The funding contained in this measure will help states purchase naloxone and facilitate the training of providers at all levels in the usage of this lifesaving medication."
For the priority area that addresses expanding use of MAT, HHS said it will do so by:
- launching a grant program in FY 2015 to improve access to MAT services through education, training and purchase of MAT medications for treatment of prescription opioid and heroin addiction, and
- exploring bipartisan policy changes to increase use of buprenorphine and develop training to assist prescribing.
Rich said this measure also increases the total funds available for MAT.
"Since many recent prescribers of medication-assisted treatment have been primary care providers such as family physicians, and many more MAT prescribers are needed to handle the number of eligible patients, any increased funding for the training of providers of MAT would clearly benefit family physicians nationwide," he said.
Grants Will Support Prescription Drug Monitoring Program
In its release, HHS specifically pointed to the recent launch of the Prescription Drug Overdose Prevention for States grants program(www.grants.gov) to provide state health departments with resources to enhance their PDMPs and advance innovative prevention efforts.
"This funding will support about 16 states in implementing robust prevention programs to improve safe prescribing practices and turn the tide on the prescription drug overdose epidemic," the release said.
The application period currently is open for all 50 states and Washington, D.C. The deadline for applications is May 8.
Rich said when they're active, PDMPs effectively allow prescribers the opportunity to look up their patients and see where and when they are getting their narcotic prescriptions filled.
"This allows providers to see if patients are getting opioid pain relievers from more than one provider," he said. "The characteristics of PDMPs can vary significantly from state to state in terms of the information that they contain and how they are accessed. Hopefully, this funding can be used to help standardize the information available to and improve access by the providers of individual states."