Public Policies to Address the Opioid Crisis
The nation is experiencing a public health crisis involving licit and illicit opioids.1,2 We endorse the following policies that support a comprehensive approach to reducing addiction, abuse, diversion, and overdose related to opioids.3
Limit the Duration of the First Opioid Prescription
We support medically appropriate limits on the duration (days’ supply) of the initial opioid prescription during a course of treatment.4 Such limits can improve prescribing practices and reduce the number of unused opioids in the community.
Use Prescription Drug Monitoring Programs (PDMPs)
We encourage prescribers to register and use PDMPs. Further, we support improved PDMP utility for clinicians, such as accessing data across state lines, allowing use by a prescriber’s delegate, and integrating information into the clinical workflow. Evidence shows PDMPs are effective in supporting appropriate clinical decision-making, reducing “doctor shopping,” and preventing prescription drug abuse and diversion.5
Require Demonstrated Competence for Opioid Prescribing
We support required demonstration of competence in opioid prescribing as a condition for initial or renewed registration with the DEA to prescribe opioid analgesics.6 Prescribers can demonstrate competency by completion of specific training on the risks and appropriate use of opioids or by certification from a relevant specialty board. Healthcare professionals who possess current and accurate knowledge of opioids are more likely to make appropriate prescribing decisions, thereby reducing risks to the individual and to the public.
Expand the Use of Naloxone
We support of increased access to naloxone, an opioid reversal agent, to reduce deaths from opioid overdose. Policies to expand use include greater availability of naloxone for use by law enforcement and other first responders, appropriate civil immunity to persons aiding in a potential overdose situation (“Good Samaritan” laws), and ability to obtain naloxone without a prescription.7,8
Expand Access to Medication-Assisted Treatment (MAT) for Opioid Use Disorder
We support affordable, culturally appropriate, convenient, and timely access to MAT.9,10 Policies to expand access to MAT include increasing workforce capacity, improving insurance coverage, and reducing stigma. Evidence shows that combining the judicious use of medications approved by the FDA specifically for use in managing opioid addiction with counseling and behavioral therapies effectively treats opioid use disorder.
Encourage Adoption of Abuse-Deterrent Formulations
We support barriers to the appropriate clinical use of opioid analgesics with abuse-deterrent properties (ADP) as recognized by the FDA. While the FDA has approved several opioids with ADP, the vast majority of opioids dispensed lack such properties.11,12 Development and use of opioids with ADP are parts of a comprehensive approach to reduce the abuse of opioid analgesics.13 All opioids, including those with abuse-deterrent properties recognized by the FDA, expose users to the risks of addiction, abuse, and misuse.
- Ahrnsbrak R, Bose J, Hedden SL, Lipari RN, Park-Lee E. Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA). NSDUH Data Review. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm. Published September 2017. Accessed October 26, 2017.
- Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. [published online December 16, 2016]. MMWR Morb Mortal Wkly Rep. 2016;65:1445–1452. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm?s_cid=mm655051e1_w. Accessed July 25, 2017.
- Office of National Drug Control Policy. Epidemic: Responding to America’s Prescription Drug Abuse Crisis.
https://obamawhitehouse.archives.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf. Published 2011. Accessed July 25, 2017.
- Section 24 of Chapter 52 of the Acts of 2016: An Act Relative to Substance Use, Treatment, Education, and Prevention.
https://malegislature.gov/Laws/SessionLaws/Acts/2016/Chapter52. Approved by the Governor March 14, 2016. Accessed July 25, 2017.
- Worley, J. Prescription Drug Monitoring Programs, a Response to Doctor Shopping: Purpose, Effectiveness, and Directions for Future Research. [published online April 30, 2012]. Ment Health Nurs. 2012;33(5):319-328. doi:10.3109/01612840.2011.654046.
- Office of National Drug Control Policy. Epidemic: Responding to America’s Prescription Drug Abuse Crisis. Healthcare Provider Education, p3, bullet 1. https://obamawhitehouse.archives.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf. Published 2011. Accessed July 25, 2017.
- Department of Health and Human Services, Assistant Secretary for Planning & Evaluation. Opioid Abuse in the U.S. and HHS Actions to Address Opioid-Drug Related Overdoses and Death. ASPE Issue Brief. https://aspe.hhs.gov/system/files/pdf/107956/ib_OpioidInitiative.pdf. Published March 26, 2015. Accessed July 25, 2017.
- State Naloxone and Good Samaritan Legislation. ONDCP https://obamawhitehouse.archives.gov/sites/default/files/ondcp/Blog/naloxonecirclechart_november2014.pdf. Published December 1, 2014. Accessed July 25, 2017.
- Lipari RN, Park-Lee E, Van Horn S. Substance Abuse and Mental Health Services Administration (SAMHSA). America’s Need for and Receipt of Substance Use Treatment in 2015. The CBHSQ Report. https://www.samhsa.gov/data/sites/default/files/report_2716/ShortReport-2716.html. Published September 29, 2016. Accessed July 25, 2017.
- Department of Health and Human Services, Assistant Secretary for Policy & Evaluation. Opioid Abuse in the U.S. and HHS Actions to Address Opioid-Drug Related Overdoses and Death. ASPE Issue Brief. https://aspe.hhs.gov/system/files/pdf/107956/ib_OpioidInitiative.pdf. Published March 26, 2015. Accessed July 25, 2017.
- U.S. Food and Drug Administration. Opioid Medications: Abuse-Deterrent Opioid Medications.
https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm337066.htm. Updated August 21, 2017. Accessed August 28, 2017.
- IMS Health NPA and NSP. Data on file. Prescriptions for opioid analgesics with ADP labeling as percentage of total prescriptions for opioid analgesics for the 12-month period ending December 2016.
- U.S. Food and Drug Administration. Fact Sheet – FDA Opioids Action Plan. Bullet 5. https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm484714.htm. Updated July 11, 2017. Accessed July 25, 2017.