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Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic
Laxmaiah Manchikanti, MD, Jaya Sanapati, MD, Ramsin M. Benyamin, MD, Sairam Atluri, MD, Alan D. Kaye, MD, PhD, and Joshua A. Hirsch, MD
The opioid epidemic has been called the most consequential preventable public health problem in the United States”. Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths.
This manuscript, featured in the July/August issue of Pain Physician, describes the escalation of opioid use in the United States, discussing the roles played by drug manufacturers and distributors, liberalization by the DEA, the Food and Drug Administration (FDA), licensure boards and legislatures, poor science, and misuse of evidence-based medicine.
Data on opioid overdose deaths shows
- 42,000 deaths in 2016
- synthetic opioids other than methadone were responsible for over 20,000
- heroin for over 15,000
- natural and semi-synthetic opioids responsible for over 14,000
- Fentanyl deaths increased 520% from 2009 to 2016
- Heroin deaths increased 533% from 2000 to 2016
- Prescription opioid deaths increased by 18% overall between 2009 and 2016.
The Drug Enforcement Administration (DEA) mandated reductions in opioid production by 25% in 2017 and 20% in 2018. The number of prescriptions for opioids declined significantly from 252 million in 2013 to 196 million in 2017.
This manuscript describes a 3-tier approach presented to Congress.
- Tier 1 includes an aggressive education campaign geared toward the public, physicians, and patients.
- Tier 2 includes facilitation of easier access to non-opioid techniques and the establishment of a National All Schedules Prescription Electronic Reporting Act (NASPER).
- Tier 3 focuses on making buprenorphine more available for chronic pain management as well as for medication-assisted treatment.