Congress finally begins to address opioid abuse

Following 18 months of sluggish deliberation on Capitol Hill, the Senate passed last week, by a vote of 92-2, a bill to address the proliferation and intensification of domestic opioid abuse.

The sprawling legislation, know as the Comprehensive Addiction and Recovery Act of 2016, authorizes the Department of Justice (DOJ) and the Department of Health and Human Services (DHHS) to award grants to stymie the dual crises of heroin use and prescription opiate overuse.

Funds will be used to expand the availability of naloxone to emergency responders; improve systems for monitoring and limiting the distribution of legal pharmaceuticals; work to identify and clinically treat addiction in the prison population; and eliminate questions regarding drug-related convictions on FAFSA applications.

Especially prominent is a section mandating that the Secretary of DHHS, Sylvia Burwell, work with leaders from the Department of Defense (DOD) and the Department of Veterans Affairs (VA) to convene a task force of medical professionals to formulate a series of best practices on pain management. That clause seems to nod to the rampant overprescription of opiate treatments by specialists, general practitioners, and nurses, which is widely viewed as a key driver of addiction and overdose.

According to the Centers for Disease Control (CDC), the sale of prescription opiates nearly quadrupled between 1999 and 2014, despite no change in the amount of pain that Americans report to their healthcare providers. That quadrupling of sales is mirrored in the multiplication of deaths resulting from opioid overdose during that period. At the turn of the century, the mortality rate stood at 2/100,000; by 2014, the figure had leapt to 8.5/100,000, with nearly half of those deaths stemming from prescription (as opposed to illicit) abuse. Burwell’s task force, then, should play a critical role in orchestrating the rapid intervention necessitated by this burgeoning public health crisis.

The legislation’s twin goals, criminal justice reform and the destigmatization of mental healthcare, have been widely regarded as presenting opportunities for cooperation and compromise in a bitterly divided legislature. Since its introduction to the Senate Judiciary Committee in February of 2015, the bill has been cosponsored by half of the members of the Senate. Backing came initially from Democrats and Republicans representing states in the north and east, including portions of Appalachia and the Rust Belt, where statistics from CDC indicate that opioid overdoses are most acutely on the rise.

The legislation has left much to be desired, especially from those who viewed the CDC’s trendlines as representing an emergency whose robust address would carry a hefty price tag. Even so, President Obama has already announced that he will sign the bill when it crosses his desk. Here’s to hoping that his signature will mark the conclusion of an introductory discussion, and the opening of a first chapter in our attempts to change the way that we perceive and treat illness in this country.

Patrick Kurth
Patrick Kurth attended Fordham College at Lincoln Center to study humanitarianism and human rights. His interests are diverse: he has recently contributed works on psychotraumatology, food anthropology, and LGBTI activism to TEDx, the School for International Training, and the World Policy Journal, respectively. Mr. Kurth presently lives in Brooklyn, where he can be found taking the metropolis at his own pace.

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  • Doris Medley

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  • Far too nuanced for anyone who doesn’t want to take the time to actually understand the issue, and the people affected.

  • Mike_in_the_Tundra

    I’m not really sure the legislatures know the difference between physical dependence and addiction.

  • It seems more like these bills to address the “opiod crisis” are more about scapegoating those of us who actually do need pain medications, as weak addicts, rather than actually addressing the overall problem of prescription misuse – which certainly doesn’t apply just to opiates. I’ve been getting my prescriptions at the same pharmacy for over a decade, and suddenly now they’re requiring me to jump through hoops every month. How does that help anyone?

  • Hue-Man

    This is in today’s newsfeed.

    “The Journal of the American Medical Association has published a review
    of guidelines developed by a pair of health authorities in British
    Columbia aimed at educating health-care providers about how best to
    treat opioid-use disorder.

    One of the guidelines’ authors, Dr. Keith Ahamad, says the protocols
    are the first to provide an evidence-based, gradual approach for how
    family doctors can best help someone addicted to opioids.”

    http://www.ctvnews.ca/health/made-in-canada-approach-to-opioid-addiction-gets-international-attention-1.2992868

  • Mike_in_the_Tundra

    I understand why doctors are afraid of prescribing pain meds, but it’s also wrong to let a patient be in severe pain.

  • Bonnie MacMahon

    I was diagnosed with small fiber neuropathy in Nov. 2014. I had ongoing pain in my feet for a year before I got the diagnosis but since then the pain has progressed to the degree that I can no longer walk or stand for more than a minute. SFN is known to be extremely painful and kill your quality of life http://tinyurl.com/jgcjvd5.

    I’ve been through 3 different neurologists and 3 different pain “specialists”. Here are the drugs I’ve been given to treat the pain:

    Pamelor
    Cymbalta
    Savella
    Lyrica
    Gabapentin
    Gralise
    Topimax
    Amitriptyline
    Trazadone
    Mobic
    Amrix
    Klonopin
    and various lidocaine/ketamine creams/gels/ patches

    I have been prescribed more antidepressants and more anticonvulsants than any other drug. NONE of these medications did anything for my pain, though the anti-Ds killed my libido and the anti-Cs put 40 pounds on me in three months time. My latest neurologist has told me he can’t prescribe me anything stronger than a muscle relaxant (lie). My last ‘pain specialist’ told me they couldn’t help me (more like didn’t want to). They tell me to ‘stay positive’ while they have me try another drug for pain that was developed for some other purpose.

    For the past year I’ve been bedridden, only getting up to go to the bathroom and to my doc appointments, because I can’t walk without severe pain. There is no doubt that I have SFN, there is no doubt it’s progressing, there is no doubt it’s painful and has stolen my ability to function, yet, not one of my doctors will prescribe me a narcotic based pain reliever. I’m 50. My life is over and none of my doctors will let me try a medication that might make it easier for me to stand on my feet. I guess they’d rather me spend money I don’t have on a motorized wheelchair (SFN affects my hands too, so I’m not able to wheel myself).

    So I suffer. Hour by hour. Day by day. Week after week. Year after year. When I look at what my future holds all I see is me being a bedridden, dependent burden. I think of how I won’t be able to help my daughters when they have children of their own. I think of how bad the pain has progressed over the past 2 years and fear the years to come.

    Do I want to be on opioids for the rest of my life? No. I don’t want to be disabled at 50 either. I don’t want to depend on other people to do simple everyday tasks for me. I don’t want to be sick, weak and unable to work, but I am. Don’t I have the right to use a medication that might make my pain easier to deal with so I can do the mundane activities I once took for granted?

    Thanks to the opioid hysteria the answer to that question is a resounding No.

    PS – I’ve tried marijuana and although it helps me sleep it actually makes me hyper aware of the pain, so that’s out.

  • Cathy Benham

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  • 您的博客拥有旺盛的生命力!!

  • JaneE

    I have kidney disease, can have zero NSAIDS and total 2 grams of tylenol. Fortunately my pain is arthritic, and highly variable. Some days zero meds, some days 6 – the NTE amount because of the tylenol they contain, not the opiates. In 15 years I have been physically dependent maybe twice. Once it took 3 days to detox once I realized it, and the maybe time about 6 hours. Even if I wind up on dialysis opiates are still usually preferred. I will be on them probably for the rest of my life – another 15 -20 years if I am lucky. My doctor tells me they are working on different pain medications, but unless I want to go the full pain management route what I have now is it.

    They keep cutting back on the number of pills they give me at a time, but that doesn’t change how much I take. Only a couple of times in the last 15 years have I needed to take them constantly. If I go for more than 2 weeks I will become dependent, and need to cold turkey again when the pain lets up, as it eventually does. It is a lot easier than quitting cigarettes was.

  • Mike_in_the_Tundra

    I have had chronic pain since 1998. This was after a traffic accident. Ultimately, I took Vicodin for almost four years. Thanks to a neural stimulator implant, great physical therapy in a pool, and education concerning pain, I was able to stop the Vicodin. Anyone who has ever taken an opioid for a long period of time will know why I welcomed stopping it. I was definitely physical dependent on the medication, but I really felt fine during the stopping process. They just decreased my dosage by half a pill each week. I am now on my second neural stimulator, and that’s my story.

    The important thing here is I absolutely needed the medication while I was taking it. Pain resolution is not reached quickly, and for many, it will never be reached. We cannot have doctors afraid of prescribing pain medication. We also cannot have patients trying to hide the fact that they are taking pain meds. Most importantly, we can’t have people in chronic pain going untreated.

  • JaneE

    I would hope that medical professionals would realize and categorize the different situations that all appear to be lumped into the “opioid problem” today.

    I distinguish between physical dependence, seen in people who use opiates to treat pain long term, and addiction which is a psychological dependence and can be applied to things like gamboling and sex.

    I would hope the medical professionals would recognize that opiates are the safest form of pain treatment for many people with other conditions, and the currently available alternatives would make those conditions worse, or add new ones.

    I hope they realize that not every person who takes opiates for pain, even long term, falls into the category of physical dependence or addiction. Reducing the amount of pain medication does not reduce the amount of pain felt – for a lot of us the reverse has been true.

    Maybe medical professionals will consider the patients they are affecting, and how the quality of life suffers with each additional hoop we need to jump through just to be able to lift a cup without crying out or cut a piece of meat.

    None of that has happened so far. I have some suggestions on what might help, but I don’t see any evidence that any of the regulators have ever thought of them.

    Educate patients on how the medication works when it is prescribed. Opiates are a problem, so invest about 2 minutes extra to make sure the patient knows what to expect. I assumed my Vicodin (on tv as a really powerful pain killer = use with caution) would a) work within half an hour and b) eliminate the pain I felt. Wrong on both counts. It took over an hour to feel any relief, and if I was in pain when I took it the relief was minimal. Taking more didn’t make it work any better. After taking a days worth in two hours and getting no pain relief, just a general numbness I realized that was not going to work. Now I take it when I get to a level of discomfort that won’t work out in a few minutes. The drugs have time to work and I don’t get to the level of “pain” very often. I am not surprised that someone in pain would take enough to kill them, just trying to get some relief.

    Give patients some education on how physical dependence occurs. How long it takes for the drugs to leave their systems, and how keeping a level of drug in their system all the time will create a dependence that doesn’t happen nearly so easily if they go completely free of the drug periodically. Let them know what the first symptoms of dependence are, so they can get treatment before the psychological addiction takes hold. And try to remember that both physical dependence and addiction are problems only if the reason to take the drug is gone. If the pain still needs to be treated, it still needs to be treated, and taking away the only way to safely treat it for that patient would do more harm than good.

  • What’s missing from that proposed law?

    Dealing with the actual causes of the problem. For one, in this country we just love scolding people who need and use pain medication, as if suffering is more noble than seeking relief. Our pain management regimes, to put it bluntly, suck donkey balls. At this point, chronic pain sufferers are increasingly being treated like suspected criminals.

    Yes, some of this is the unavoidable result of actual criminals abusing these medications, but hell, we’re at the point now where a person who is literally days away from dying and in agony is often treated as if potential addiction is a concern.

    The other problem comes from the pharmaceutical company side. Many of the most commonly prescribed pain medications are formulated all wrong. A sensible regime would be smaller amounts delivered more frequently. Yet since the 1980s, the pharma companies have been moving toward pills intended to be taken once every 12 hours. Only the half-life of these meds in the human body is such that by time it’s 6-8 hours in, they’re already wearing off. With the pain coming back, it’s a feedback loop that causes dependence and a far higher chance of longer-term addiction.

  • Badgerite

    My God. The GOP Congress actually did some kind of actual work before leaving town. This is so long overdue it is ridiculous.

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