July 30, 2018

Annual 2018: Several professions unite to urge multidisciplinary approach to opioid epidemic

The Centers for Disease Control and Prevention has called the use of opioids the worst drug addiction epidemic in U.S. history. And it will take everything in the country’s arsenal to eradicate it.

“There is no magic bullet,” warns Dr. Nirav Shah, director of the Illinois Department of Public Heath in Chicago. “With the opioid crisis, there were 20 different reasons or factors that led to this crisis as we know it today and because of that there are going to be 20 or 30 different things that we will need to do in order to get us out of this.”

Shah, who was a practicing attorney before taking his current position, is one of three medical experts who will be participating in a panel discussion, “Opioids in America: A Multi-Disciplinary Discussion on Cause, Effect & Solutions,” during the American Bar Association Annual Meeting Aug. 2-7 in Chicago. The program will be held on Thursday, Aug. 2., from 9-10:30 a.m. at the Hyatt Regency Chicago, West Tower, Concourse Level, Comiskey. The program is sponsored by ABA Criminal Justice Section. Joining Shah on the panel will be moderator Eileen Gallagher Loranger of the American Academy of Periodontology in Chicago and Dave Preble, senior vice president of the American Dental Association in Chicago.

The program will bring together leaders of the medical, dental, medical examiner and legal professions and will serve as a catalyst in identifying a multi-disciplinary approach necessary to tackle the opioid epidemic.

Potent and lethal synthetic drugs, easy access to prescription drugs and the rise of heroin among younger drug users all combined to create today’s deadly and far-reaching crisis. The statistics from 2016 (the most recent) are staggering:

  • 116 people died every day from opioid-related drug overdoes
  • 42,249 people died from overdosing on opioids; of that 19,413 deaths attributed to overdosing on synthetic opioid other than methadone
  • 11.5 million people misused prescription opioids
  • 2.1 million people had an opioid use disorder
  • 948,000 people used heroin
  • 15,469 deaths attributed to overdosing on heroin
  • $504 billion in economic costs.

The epidemic has affected every state in the country, making the issue a top priority of the White House, Congress, the medical community and law enforcement. The justice system is being overwhelmed by prosecuting and defending drug crimes while also striving to identify better ways to manage and treat chronic drug abuse with the resources available to courts. And, doctors and dentists struggle with the appropriate way to manage acute and long-term pain issues, which traditionally have been treated with opioids such as painkillers oxycodone, hydrocodone, codeine, morphine and fentanyl.

One reason for the rise in opioid abuse is the increased ease by which individuals can obtain prescription medications.The number of opioid prescriptions dispensed by doctors steadily increased from 112 million prescriptions in 1992 to 236 million in 2016.

“The education, discussion and the debate fostered by the ADA is already making headway toward reducing opioid prescribing in the dental community,” Preble said. “Our goal is to help the health-care provider understand that if an opioid is needed to manage pain it can be a very small dosage for limited duration, and that it can be done in a combination with a non-opioid such as ibuprofen. Those two things put together make the amount of opioid being prescribed in the dental community be so small that it wouldn’t have an impact on the opioid crisis.”

The government is also taking a multifaceted approach to solve the crisis.

  • In February, President Donald Trump signed a budget agreement authorizing $6 billion for opioid programs over the next two years, and the White House in June announced a new multimillion- dollar public awareness advertising campaign using real-life stories.

  • Attorney General Jeff Sessions announced in February a new opioid initiative, the Prescription Interdiction & Litigation Task Force to support local jurisdictions that have filed lawsuits against prescription drug-makers and distributors.

  • In April, the U.S. Surgeon General issued a rare advisory recommending that Americans carry the opioid overdose-reversing drug, naloxone.

  • Congress is crafting legislation that includes 40 bipartisan proposals intended to expand the ability of multiple government agencies to address the ongoing crisis. Provisions in the bill would encourage further research at the National Institutes of Health to develop nonaddictive painkillers, urge the Food and Drug Administration to recommend certain limits on the number of opioids prescribed to a patient and call on the Centers for Disease Control and Prevention to collect more data about overdoses, which officials can then use to more effectively combat the epidemic.

As Illinois’ public health director, Shah said programs his state put into place are already making a difference.

“The first thing we did last year was sign a standing order allowing people to buy naloxone at any pharmacy without a doctor’s prescription,” Shah said. “Secondly, in Illinois and almost every state now, physicians are required to check before dispensing a prescription for an opioid. It’s called the prescription monitoring program. When they find patients who they believe might be doctor-shopping to game the system, they are able to cut those patients off and really ultimately save their lives.”

One of the ongoing debates about the opioid crisis is whether the abusers, pharmaceutical companies and even doctors should face criminal charges as a result of the abuse. Shah acknowledges that while there might be criminal activity involved, the bigger focus should be on treatment rather than incarceration.

“Individuals with substance abuse disorder have a complex mental health issue and what I like to tell people is that we are not going to be able to arrest our way out of this crisis,” Shah said. “Arresting somebody and putting them in jail is one of the more counter-productive things we can do. Law enforcement is one of the biggest advocates of treating people with substance abuse as patients.”

Shah said he hopes those attending the panel discussion will take away a better understanding about how the crisis came about — “There is no one “bogeyman in the causation of this crisis” — and a sense of hope.

“Although this is a very difficult crisis that we are facing, there are positive signs on the horizon,” Shah said. “This problem, like many other problems our society has faced, can be solved.”