Policy Brief: Opioid Crisis

Policy Brief: Opioid Crisis
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Policy Brief: Opioid Crisis
Opioid abuse and addiction have dramatically increased, causing a major public health concern. According to the Centers for Disease Control and Prevention (CDC), opioid use globally has multiplied over the last two and half decades. The sale of these drugs has also augmented tremendously. The rapid demand and supply of opioids are partly attributed to the easy accessibility of the drug due to its use in pain treatment. The prescription of opioids in pain treatment has exposed many people to addiction triggered by overprescribing. Surgeons have a responsibility to reduce their patients’ pain after the operation. It is also their responsibility to avoid overprescribing. Unfortunately, some providers have failed to honor this role. Currently, opioid overdose and addiction are increasing alarmingly, leading to high rates of opioid-involved deaths. The ongoing opioid epidemic necessitates robust efforts to combat the problem. Addressing this crisis requires crucial, evidence-based approaches focusing on clinical, policy, and educational aspects.
Problem Statement
The opioid crisis is one of the twenty-first century's most devastating public health concerns, with opioid misuse, addiction, and overdose augmenting over the last two and a half decades. Worldwide, over 275 million people aged 15-64, representing about 5.5% of the global population, used drugs at least once in 2019 (World Health Organization, 2021). Among them, approximately 62 million people use opioids, and the number is growing (WHO, 2021). Most opioid dependencies are attributed to illicitly cultivated and manufactured heroin. The alarming rise in opioid misuse has led to a public health problem with a dramatic increase in opioid-related deaths (Jalali et al., 2020). According to the WHO (2021), over 70% of drug-related deaths are linked to opioids, with overdose accounting for more than 30% of those deaths. The WHO (2021) estimated that at least 115,000 individuals died of opioid overdose in 2017.
Recently, several countries have witnessed an increase in opioid overdoses due to the increased use of opioids in chronic pain management and the continuous availability of highly potent opioids on the illicit drug market. In the United States alone, opioid-related overdoses have claimed more than 564,000 lives since 2000. In 2020, about 91,799 drug overdose deaths occurred in the U.S. for an age-adjusted rate of 28.3 per 100,000 standard population (CDC, 2022). Almost 75% of those deaths involved opioids (CDC, 2022). From 2019 to 2020, opioid-involved death rates significantly changed.
Opioid-related death rates increased by 38%, and prescription opioid-involved mortality rates rose by around 17% (CDC, 2022). Deaths related to synthetic opioids, excluding methadone, increased by 56% (CDC, 2022). These deaths contributed to a life expectancy decline that the U.S. has experienced since 2014. Opioid use can lead to death because it affects the part of the brain that regulates breathing. An overdose occurs when opioids excessively stimulate the brain stem, leading to respiratory depression and death.
Other effects of the opioid problem include the broader spread of infectious diseases like HIV, hepatitis C, and bacterial infection caused by sharing injection instruments like needles (Congressional Budget Office, 2022). Studies show that these impacts are not limited to users only. They extend to their families and communities. For instance, the number of newborns experiencing withdrawal due to their mothers' opioid use has escalated. The neonatal abstinence syndrome (NAS) rate has also increased due to exposure to opioids before birth (Fast Track Action Committee, FTAC, 2022). A recent multi-state analysis of the opioid crisis among delivery hospitalizations in the U.S. reported an increase in the prevalence of opioid use disorder, from 1.5 cases per 1,000 delivery hospitalizations to over 6.5 cases per 1,000 delivery hospitalizations (FTAC, 2019). These consequences carry a significant economic burden.
According to the Congressional Budget Office (2022), the opioid problem has affected revenues and spending in the federal budget. Federal spending on healthcare, means-tested social programs, the child welfare system, and drug trafficking reduction efforts has increased (Congressional Budget Office, 2022). Tax revenues have also suffered a major setback due to the lost earnings from reduced longevity and productivity of opioid users (Congressional Budget Office, 2022). The FTAC report indicated that the economic cost of opioid misuse exceeds $504 billion (FTAC, 2019).
Options to Solve the Problem
1 Medication-Assisted Treatment
Medication-assisted treatment (MAT) is an evidence-based practice that combines medication with behavioral interventions to effectively treat opioid use disorder (OUD) and help users sustain recovery. The U.S. Food and Drug Administration (FDA) has approved methadone, buprenorphine, and naltrexone for treating opioid use disorder (Skolnick, 2018). The agency has confirmed the safety and effectiveness of these drugs when combined with counseling and psychosocial support (Skolnick, 2018). Everyone seeking treatment for OUD should be allowed to access all the medication as it enables the providers to engage patients in selecting the best treatment for their needs. Increasing access to MAT for OUD patients will increase an individual's ability to make that decision and will be crucial in addressing the opioid crisis.
Due to OUD’s chronic nature, providers should re-evaluate the need for continuing MAT. These medications work by normalizing brain chemistry, blocking opioids’ euphoric effects, reducing physical cravings, and preventing withdrawal without adverse effects (Skolnick, 2018). They target mu-opioid receptors within the endogenous opioid system, although each has a distinct action mechanism (Mancher et al., 2019). Their safety and efficacy profiles vary due to their differing pharmacodynamics, pharmacological and pharmacokinetic characteristics (Mancher et al., 2019).
OUD is characterized by continued use of opioids or feeling unable to control opioid use despite the negative consequences. People who genuinely want to stop these cravings may experience withdrawal symptoms, anxiety, depression, insomnia, tremors, and muscle aches, among other side effects (Skolnick, 2018). Therefore, opioid medication helps individuals overcome their cravings. However, they must be supplemented with counseling and behavioral therapies to facilitate a full recovery. A study to investigate outcomes from the MAT pilot program in rural Colorado, US, showed decreased opioid use, reduced opioid-related symptoms after six months, and improved physical and psychological health among drug users (Amura et al., 2022). Based on the findings, the study approved MAT as one of the most effective solutions to the opioid crisis. This strategy has been used in the U.S. and other countries worldwide.
Project Lazarus, a MAT model developed in Wilkes County, North Carolina, has demonstrated the success of this strategy. Project Lazarus (P.L.) is a seven-strategy intervention designed to address the opioid problem (Alexandridis et al., 2019). The seven strategies include community education, support programs, addiction treatment expansion, policy change, and diversion control (Alexandridis et al., 2019). The P.L. program addresses common fallacies about OUD and resistance to MAT prescription. It encourages healthcare providers to obtain buprenorphine waivers and offer this treatment option in their communities.
Despite several studies indicating the effectiveness of MAT, this strategy is not widely used. Critics have questioned its success, perceiving it as a method of replacing one addictive substance for another, given that methadone and buprenorphine are opioids (Mancher et al., 2019). This misconception contributes to MAT resistance. However, scientific evidence maintains that MAT works effectively for opioid patients. Under the supervision of providers authorized to administer the medications, these drugs have been proven to reduce and eliminate opioid cravings and withdrawal symptoms as well as minimize high-risk behaviors (Mancher et al., 2019).
2 Policy Implementation
Weak policies contribute to the high demand and supply of opioids. Many opioid deaths are linked to illicit opioids like heroin and illegally manufactured fentanyl. The SUPPORT for Patients and Communities Act contains significant policies aimed at minimizing opioid demand. The provisions in the Act range from accessibility of Medicare and Medicaid Services to restriction of importation of non-regulated drugs (Davis, 2019). In one provision, the Act strengthens access to and use of treatment among opioid addicts enrolled in Medicare and Medicaid. The provisions of Medicaid extend eligibility to specific young adults and enhance federal requirements and support for Medicaid coverage of OUD treatment (Congressional Budget Office, 2022). For instance, Medicaid provisions allow young adults involved in foster care and the criminal system to access Medicaid services and retain coverage (Congressional Budget Office, 2022).
Medicare provisions expand access to telehealth services for OUD for Medicare beneficiaries and coverage for treatment at opioid treatment programs. Other provisions require annual OUD screening for beneficiaries and fund clinician pharmacotherapy training (Davis, 2019). The Act also requires the FDA to restrict the entrance of illegal drugs by developing and periodically updating the list of controlled substances. Under this policy, the FDA is authorized to prevent anyone from importing an FDA-regulated product...