The numbers are in for 2016, and they are not good. According to the National Center for Health Statistics, Centers for Disease Control and Prevention, drug-related overdoses in the United States reached their highest level. What’s more, the rate of drug overdose deaths for people under the age of 50 is occurring at a faster rate than HIV at its peak. Given the rise of fentanyluse and easy access to heroin, the number of deaths from opioids is likely to climb for this year. The New York Times published a revised breakdown of data related to the opioid epidemic. Equally as troubling with the numbers is the news that prescription opioid-related deaths have leveled off, while cocaine and methamphetamine have reared their ugly heads as contributing factors in the surge of fatalities.
So far, the recommendations made by the newly formed Commission on Combating Drug Addiction and the Opioid Crisis appear to be unoriginal and vague. The effort to have real mental health parity in the treatment of mental health and substance abuse disorders has been echoed for decades to no avail. While the commission encourages easier access to opioid replacements (“MAT”) such as subutex , there is a greater need to understand and analyze the reason drug use is on the rise across various socio-economic, cultural and racial groups. The epidemic has not and is not affecting just white suburbanites, inner city minorities and Appalachia. In fact, the three states that saw the highest increase in opioid-related deaths were Delaware, Florida and Maryland.
State legislators have begun to implement prescription drug monitoring programs to detect the rate patients have been prescribed pain medication. However, this system regulates the patient, not the doctor. It is widely known that doctors (see pill mill crisis of 2011) routinely overprescribe, but 300 million prescriptions for pain medication were written in 2015. The commission does discuss the need for more screening tools to assess addiction and pain, but tools already exist.
One place to look for a new solution is the state of Ohio, where new rules for prescribing opioids caps doctors at dispensing a maximum of 7-day prescriptions for adults in chronic pain. Additionally, the state will require diagnostic codes on all prescriptions for pain medications beginning in December.
As I have written about in the past, practioners on all levels who work in medicine, psychology, addiction and the like, must look at the rise of addiction from a multi-disciplinarinary approach. The guidelines and suggestions handed out by the commission focus primarily on reactive measures. Those on the front line of treating the epidemic must return to analyzing family structure, mental health pathology, performance in school and other societal factors that are being sidelined as explanations for the explosion in opioid-related disorders and subsequent fatalities.