For the first time in 83 years, people in the United States are more likely to die of drug poisoning than in a motor vehicle accident. The national prescription painkiller epidemic is largely to blame for this shift, and approximately 41 people in the United States die every day of a drug overdose involving prescription painkillers. Communities have been struggling to deal with not only the mortality associated with this epidemic, but also the increase in crime related to prescription drug trafficking and the rapidly-increasing number of patients needing substance abuse treatment.
The national response to the prescription drug epidemic up until now has focused on education of health care providers and the public; tracking, monitoring, and appropriate disposal of prescription medications; and law enforcement. All of these strategies focus on preventing new incidence of prescription drug misuse, however, they do not offer solutions for people that have already become addicted to these medications. There are an estimated 2 million new nonmedical users of painkillers every year, so it is clearly important to prevent new incidence of prescription drug misuse. However, our response needs to include services for the 1.9 million people that need treatment for painkiller addiction now.
The most proximal intervention to prevent painkiller (opioid) overdose deaths is to administer, either intravenously or intranasal, naloxone, an FDA-approved medication with well-established efficacy and safety. Naloxone, also known as Narcan, is available with a prescription and can be administered to reverse an opioid or heroin overdose -- potentially preventing a fatality. However, very few people seem to be aware of naloxone, and it's unclear how many states require paramedics or first-responders to carry it.
Naloxone is a safe and easy-to-administer drug; even non-medical people can administer it with minimal training. This is important because people, even uninvolved bystanders, who witness a drug overdose may be reluctant to call 911, fearing legal consequences such as arrest on possession charges. Furthermore, emergency responders may not arrive in time to reverse the overdose -- which is more likely to happen in rural areas that have higher rates of painkiller overdose deaths. A pilot naloxone program in Massachusetts estimated that 1,000 overdoses were reversed over a period of four years. Preliminary data from Project Lazarus in North Carolina found that their overdose prevention program reduced the death rate by 38 percent in Wilkes County. There are approximately 188 overdose prevention programs in the United States that are distributing naloxone to drug users and their family members, but this does not seem to be proportionate to the magnitude of the epidemic. To make matters worse, many of the states with the highest rates of overdose deaths have no naloxone distribution programs.
Earlier this month, the FDA held a public workgroup on expanding access to naloxone. The overwhelming consensus among the attendees was that access should be expanded nationally. It's unclear how or when this will happen, however, because the regulatory barriers to making this medication available over-the-counter are formidable. There is only one naloxone distributor in the United States, and existing programs are reporting problems getting naloxone. The most heart-breaking part of the FDA public workgroup was hearing testimony from parents who wished they knew about naloxone before their children died of observed overdoses.
In order to reduce overdose deaths, we need to increase public awareness and access to naloxone. But undermining our efforts to prevent overdose deaths is a much larger philosophical problem -- the wide-spread belief that medications should not be used to treat addiction despite the overwhelming scientific evidence supporting their safety and effectiveness. Patients treated with FDA-approved medications for opioid addiction are less likely to relapse or die. We have waged a war against drugs instead of formulating a science-based response to a public health epidemic for which a life-saving medication is available.
Our national response to the prescription drug epidemic should reflect our understanding of addiction as a chronic relapsing brain disease, and the fact that patients can recover when they receive evidence-based treatment. Addiction is a medical problem, not a criminal problem or moral failing. Health care providers and patients should be making treatment decisions together, able to consider both psychosocial and medication treatment options that best support patients' recovery.
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