Stopping the opioid epidemic: Experts issue recommendations to prevent overdoses

The report calls for changes to the way first responders are equipped to treat overdoses, which are killing 44 people each day in the US

BALTIMORE — Public Health experts released new recommendations aimed at stemming the prescription-opioid epidemic, a crisis that kills an average of 44 people a day in the U.S.

The report calls for changes to the way emergency responders are equipped to treat overdoses, medical students and physicians are trained, prescriptions are dispensed and monitored, and those with addiction are identified and treated.

"What’s important about these recommendations is that they cover the entire supply chain, from training doctors to working with pharmacies and the pharmaceuticals themselves, as well as reducing demand by mobilizing communities and treating people addicted to opioids," says Andrea Gielen, ScD, ScM director of the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School.

AP Photo/Toby Talbot

The recommendations were developed by professionals from medicine, pharmacy, injury prevention and law. Patient representatives, insurers and drug manufacturers also participated in the process.

The call to action comes at a time of heightened awareness about the prescription opioid epidemic. More than 16,000 people died in the U.S. from overdoses related to opioid pain relievers in 2013, four times the number who died in 1999, according to the U.S. Centers for Disease Control and Prevention (CDC).

Prescription opioid sales have increased 300 per cent since 1999. The CDC estimates that two million Americans were dependent on opioid medications in 2013.

Two of the recommendations are to expand the availability of naloxone, and to develop more secure and tamper-resistant packaging through design contests and other approaches.

The report, titled "The Prescription Opioid Epidemic: An Evidence-Based Approach," breaks its recommendations into seven categories:

  • Prescribing Guidelines.
  • Prescription Drug Monitoring Programs (PDMPs).
  • Pharmacy Benefit Managers (PBMs) and Pharmacies.
  • Engineering Strategies (i.e., packaging).
  • Overdose Education and Naloxone Distribution Programs.
  • Addiction Treatment.
  • Community-Based Prevention Strategies.

"This is a complex epidemic with no simple solutions," says G. Caleb Alexander, MD, MS, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness at the Bloomberg School. "We tried to identify as many windows as possible, and to tie together as much research as available, to inform these recommendations which together we believe provide the best chance of turning this steamship around."

The report calls for stricter oversight of clinical prescribing and more comprehensive training of medical students, who presently receive very little instruction on the subject. The signatories also recommend expanding the role of pharmacies and Pharmacy Benefits Managers, both of which stand between the prescribers and the patients who receive the medication. For example, increased use of electronic prescribing to identify high-risk patients and prescribers, along with expanded availability of drug take-back programs, would give pharmacies a greater role in reducing opioid misuse and abuse.

The authors also call for mandatory use of Prescription Drug Monitoring Programs (PDMPs), state databases that include controlled substance prescriptions from in-state pharmacies. At present, PDMPs are voluntary in many states and actual use varies — many prescribing providers are not aware of them — and their design varies from state to state. In addition to making PDMPs mandatory, the report recommends making them more accessible to law enforcement when warranted.

Among the recommendations to address addiction, working group members call for providing funding for treatment programs to communities with high rates of addiction and educating prescribers and pharmacists on ways to prevent addiction.

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