Drug overdose deaths now surpass all other accidental causes of death, including car accidents and gun incidents combined.
Surprisingly, while heroin seems to be the focus, prescribed medications kill more people via overdose than all other illicit or illegal substances combined. Prescribed opioids, benzodiazepines and other psychotropic medications all play a role in the current healthcare crisis.
Over 75% of persons addicted to heroin report that they were first addicted to prescribed narcotic painkillers. Sadly, overdoses do not account for all deaths within the healthcare crisis. Hepatitis C is killing nearly as many people per year as overdose deaths with the primary transmission of the disease being shared needles, though other methods of transmission are possible extending the risk of transmission to non-using population as well. Suicide rates are at an all-time high and many are directly related to the desperation people who are addicted feel when they cannot get the help they need and feel hopelessly trapped in their addiction. It is believed more than a half million people have died from this addiction epidemic since 2010.
Though many measures will be necessary to effectively combat this health care crisis, here are several measures believed to be urgent by Truth Pharm, a national non-profit awareness, education and advocacy organization who assisted in advising me for an effective plan which will be my focus in Congress.
Fund CARA –
In July of 2016, both the House and Senate passed the Comprehensive Addiction and Recovery Act (CARA), the first comprehensive bill package to address addiction in over 40 years. The bill is indeed comprehensive, providing for more prevention, care, treatment and recovery while also addressing issues with incarcerated individuals to provide treatment, transitions and recovery support for those suffering from mental health issues and addiction. It has been estimated that CARA needs at least $1.1 billion to be properly funded. The funding was not approved with the passage of the bill. In order for CARA to be effective, it must be properly funded. I will advocate for the proper funding of CARA.
Emergent Care –
Emergency Rooms: If a person overdoses they are taken to the emergency room by the attending first responding agency. Sadly, few hospitals provide treatment when the person shows up at the emergency room. Worse, it is startling to know and hard to fathom, there is no standard protocol for emergency rooms to follow when a person overdoses and is taken to an emergency room. Because of this, many people are released too soon and many will overdose again, sometimes within hours and requiring revival with naloxone again. We must have the American Medical Association release a Standard Protocol for Care for emergency room care after an overdose.
First Responders: At this time, there is no requirement for first responders to carry the lifesaving overdose reversal medication, Naloxone. With this health crisis sweeping across the United States with an ever increasing number of deaths, we can no longer rely on hopes that each first responding agency will choose to carry Naloxone. This must be standard practice and the expectation.
A Nationwide Prescription Monitoring Program: It is reported that 80% of those who use prescription drugs recreationally obtain them from friends and family. It is clear, over prescribing and diversion of medications is an issue. Currently there are no federal mandates for prescription monitoring programs. Several states have enacted statewide prescription drug monitoring programs to reduce diversion of medications from recreational use. One of the problems with statewide monitoring programs, is it is easy enough for a person to cross state lines to avoid red flags within their state’s monitoring program to obtain prescriptions either for personal use or to sell. A nationwide prescription drug monitoring program (PDMP) would eliminate this issue.
Evidence Based Practices: Currently the government only funds Evidence Based Practices for prevention programs. The current Evidence Based Programs focus on total abstinence and view alcohol, cigarettes and marijuana as the gateway drugs to heroin addiction. Studies have shown that a person who uses marijuana is 3 times more likely to use heroin. However, a person who uses narcotic painkillers recreationally is 40 times more likely to use heroin. Additionally, over 75% of people addicted to heroin report they were first addicted to narcotic painkillers. All evidence shows the current gateway drug for heroin use is narcotic painkillers. Therefore, the programs currently being funded are not up to date with current studies. Additionally, with the ever escalating rate of persons using or becoming addicted to opioids or dying as a result of them, it can be see, the current prevention programs are completely ineffective. New prevention programs must be explored, based on the information regarding this epidemic and implemented as soon as possible.
Physician Education: The greatest prevention measures that can be taken start within the same industry where this problem started – in doctors’ offices. With the ever increasing rate of prescribing of narcotics, the number of people addicted and dying of overdoses has paralleled the rate of increase. Physicians must be educated on the addictive nature of narcotic painkillers and in turn, educate their patients each time a prescription is written. They must also warn people of the dangers of having medications in their home that could be used, diverted or misused by others. Many patients do not realize, a few days’ supply of certain common medications is enough to kill a teenager within their home.
Eliminate barriers to medications that treat addiction: Medical Assisted Treatment (MAT) via Suboxone, Methadone and Vivitrol are proven to have high success rates for those seeking recovery from heroin addiction. Currently, Suboxone and Methadone require a special license for physicians to prescribe. There are no other medications that require a special license to prescribe. Even narcotic medications which are proven to be addictive and have a high rate of street diversion do not require a special license to prescribe and there are no limits set for prescribing. Suboxone and Methadone, however, require a physician to obtain a special license to prescribe, involve significant record keeping, are monitored by the DEA and physicians are limited as far as the number of patients they are allowed to treat or prescribe to. Though these limits were recently increased, due to the certification requirements, excessive bookkeeping and onerous reporting responsibilities, many physicians are not increasing the number of patients they are seeing. Considering the fact that the narcotic within suboxone and methadone are identical to the prescribed narcotic painkillers which have no restrictions, special licensing or limits for prescribing, there is no logical reason for these medications to have separate certifications, level of responsibility or limits. These need to be lifted to increase physician participation in the treatment of opioid dependence, increase accessibility to treatment, reduce the stigma associated with obtaining treatment, to reduce the cost to insurance and Medicaid and to have an immediate impact on the opioid epidemic.