Opioid Abuse Epidemic in the US

Jasmine Shah
UIC P4 Pharmacy Student
Drug Information Center
Prompted by a question to the DI center regarding investigating
the Final Rule released by the DEA which has just taken effect
on October 9
th

The Final Rule: created in an effort to decrease pharmaceutical
controlled substances in the home, thereby reducing the risk of
diversion or harm in light of the opioid overdose epidemic
1) Regulate and make stricter the ways in which controlled
substances can be disposed of
Must be non-retrievable
2) Allow for an expansion of take-back methods and centers
Prompted by a question to the DI center regarding investigating
the Final Rule released by the DEA which has just taken effect
on October 9
th

The Final Rule: created in an effort to decrease pharmaceutical
controlled substances in the home, thereby reducing the risk of
diversion or harm in light of the opioid overdose epidemic
1) Regulate and make stricter the ways in which controlled
substances can be disposed of
Must be non-retrievable
2) Allow for an expansion of take-back methods and centers
DEA Final Rule
allowing law enforcement to voluntarily continue to
conduct take-back events, administer mail-back programs,
and maintain collection receptacles
will allow authorized manufacturers, distributors, reverse
distributors, narcotic treatment programs (NTPs),
hospitals/clinics with an on-site pharmacy, and retail
pharmacies to voluntarily administer mail-back programs
and maintain collection receptacles
What is the opioid overuse epidemic?
Over the past two decades, an opioid epidemic with adverse
consequences has escalated
Can be contributed to a variety of factors including increased
prevalence of chronic pain, misguided notions, and new algorithms to
treating pain


data from the CDCs Policy Impact: Prescription Painkiller Overdoses
Factors contributing to the epidemic
the introduction of the concept of pain as a fifth vital sign
new pain management standards by the Joint Commission
on the Accreditation of Healthcare Organizations (JCAHO) in
2000, putting pressure on hospitals and physicians to
overprescribe
misconceptions of pain treatment by patients, leading to a
false belief that all pain can and should be completely
relieved by medications

"This is an out of control epidemic, not caused
by a virus or a bacteria.
This epidemic has been caused by a brilliant
marketing campaign that dramatically
changed the way physicians treat pain.

-Andrew Kolodny, chairman of psychiatry at
Maimonides Medical Center in New York
The potential dark side of the opioid epidemic
When evidence-based medicine isnt
practiced
Misconceptions that began to arise gradually:
The risk of addiction is low in patients who obtain their narcotic
painkillers legitimately
There is no maximum dose of the drugs that can't be safely
prescribed nor a maximum length of time
People who seek more frequent prescriptions or higher doses of
the drugs aren't addicts, they are "pseudoaddicts" who just need
more pain relief and more opioids
End result: It was touted that opioid medications were effective
for many types of non-cancer pain, and could be used for long
periods of time at high doses safely and with low addiction
potential


But the truth was


There was no rigorous data or studies showing that opioids
were safe and non-addicting in the long-term or at high doses
An April 2011 paper in the Archives of Internal Medicine found
that as dose escalated the risk of opioid-related death
increased. For high-dose patients the risk of death was three
times greater than in lower-dose patients.
The National Institute on Drug Abuse says addiction rates
among chronic pain patients have ranged from 3% to 40%, but
these may be even higher in certain subpopulations
Tolerance to opioids develops rapidly, requiring escalation of
doses to achieve the same level of pain relief


Medication-Assisted Therapies Tackling the Opioid-Overdose Epidemic. n engl j med 370;22
The DEAs Final Rule
Rationale
A study investigated 250 pts who were prescribed opioids for
surgery. A sample size was interviewed, and the study found
that an average of 19 tablets per pt remained unused, leaving
4,639 pills left over.
Take-back receptacles will hopefully reduce the number of
opiates in the wild (leftover drugs)
Obstacles
Will require additional costs to be taken upon those centers and
pharmacies which choose to be authorized collectors
Requires pro-activity on the part of the patient to dispose of
their leftover controlled substances
Only targeting the population of those who are not intending to
misuse/sell
data from the CDCs Policy Impact: Prescription Painkiller Overdoses
The Final Rule will ideally impact
Other potential solutions
for a multi-faceted problem
Physician education and better screening for high risk patients
Prescription Drug Monitoring Programs
Currently only 36 states
Federal and State Laws
Reversal agents
Substance Abuse Programs
Public Education
Such as in the case of antibiotic overuse

Opioid Overdose Reversal Kit
Rationale
Opioid overdose-related deaths
can be prevented when naloxone is
administered in a timely manner

Naloxone injection has been
approved by FDA and used for
more than 40 years by emergency
medical services (EMS) personnel
to reverse opioid overdose and
resuscitate persons who otherwise
might have died in the absence of
treatment

Controversy
Who should have access?
Movie Rec
-Documentary focusing on the opioid
and heroin problems faced in the
teen subpopulation of Orange County
Questions?
Please contact me if you would like references to any of the
graphs/data!