Practically every community in America, and most families, are facing the still-growing opioid epidemic that is tearing at the soul of our health and wellbeing.
The Centers for Disease Control and Prevention estimates 115 Americans die each day from opioid-related overdoses, and research suggests that misuse of prescription opioids is a risk factor for heroin use. It is thus critical that we find policy solutions that both turn the tide on opioid misuse and addiction now and make it less likely that we repeat in the long-term the same mistakes that led to the crisis.
To do so successfully, we must first fully understand the many fundamental drivers of this crisis; there is no single root cause of the epidemic, and multiple segments of society bear some responsibility.
As former policymakers committed to finding lasting solutions, we recognize the sometimes unintended consequences of well-intentioned policy. The leading example is the overprescribing practices that began 20 years ago: At that time, physicians — and patients, hospitals, insurers and the rest of the care system — were introduced to the concept of treating pain as a fifth vital sign (in addition to pulse, blood pressure, body temperature, and respiration).
As attitudes about treating pain began to shift, the demand for pain medication within the health care community dramatically increased and the drug supply chain responded. Treating pain quickly became a cornerstone in medical training and education and resulted in new prescribing guidelines. Well-meaning doctors, following the new standards but not aware of the long-term addictive effects of these drugs, prescribed opioid medications in greater doses and for longer periods in order to achieve best care for their patients, as they were trained to do. This “best practice” at the time unfortunately helped catalyze the dreadful epidemic our country now confronts, both by increasing risks to patients and by contributing to a massive increase in supply and, subsequently, opportunities for illegal use of family members’ or acquaintances’ prescriptions.
But, there are other contributors to the opioid epidemic in America, including: Aggressive marketing tactics targeting providers; the rising price of drugs, like naloxone, aimed at countering the effects opioid overdoses; coverage gaps and reimbursement policies that favor opioids over non-opioid and less addictive pain medications; and inadequate care coordination and monitoring that enables patients to “shop” for prescriptions drugs among providers. Underpinning all of this is the cultural misunderstanding of this devastating disease, which creates social stigma and prevents individuals from seeking care. Plus, when people do seek treatment, our thin mental health and substance abuse treatment infrastructure cannot keep pace.
We are all now bearing the cost of our collective and compounded errors and missteps.
Changing best practices and market demand won’t happen overnight. But as we look to the path ahead, we see signs for optimism. The CDC’s 2016 Guideline for Prescribing Opioids for Chronic Pain was a major step forward. It calls for prescribers to adopt a holistic approach to pain management, including considering non-pharmacologic solutions like behavioral or physical therapy. It recommends that prescribers consider how to wean patients off of opioid therapies while treating and reducing the harms of opioid abuse.
And, recently, both public and provider awareness and education has increased, which has likely played a role in the national decline in opioid prescriptions, as the CDC recently reported.
Meanwhile, the U.S. Senate and House of Representatives are moving on a series of bipartisan bills aimed at tackling the epidemic. Policymakers are exploring policies requiring, for example, incentives to encourage the research and development of non-addictive pain medication, electronic prescribing for controlled substances, the expansion of Medicare and Medicaid prevention and education initiatives, greater enforcement along the drug supply chain and greater access to medication-assisted treatment. If passed, these policies could help turn the tide on our current crisis.
Perhaps most importantly, the private sector has stepped up, already putting into place some of these solutions. Insurers, pharmacy benefit managers and health care systems are aggressively establishing policies to help curb the epidemic, including making overdose-reversal medication available over the counter and limiting opioid prescriptions to five- or seven-day supplies.
We applaud all of these and the many other ongoing efforts.
But more can and should be done. First responders need more access to overdose-reversal medications like naloxone. The roles of law enforcement and the criminal justice system must be re-evaluated to better address opioid and other addictions. Improved reimbursement polices are needed to incentivize the greater use of other, equally effective pain treatment therapies. And our society must accept that addiction is a devastating disease that shouldn’t be hidden away.
These and other solutions will require not only investment of money, but also time, cooperative effort and a national commitment to solving this crisis.
In the face of past national challenges, Americans have acted with resolve and clear-eyed purpose, putting partisan differences aside for the good of the country. The opioid crisis is one such challenge, and it demands the same comprehensive response. Only then can we halt the loss of life and prevent the next crisis.
Former Sen. Bill Frist, M.D., R-Tenn., and former Sen. Tom Daschle, D-S.D., were U.S. Senate majority leaders and are co-chairs of the Bipartisan Policy Center’s Future of Health Care Initiative. Frist is a nationally recognized heart and lung transplant surgeon and co-chair of the Bipartisan Policy Center’s Future of Health Care Initiative. Daschle is the founder and CEO of The Daschle Group.