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Experts Call for Expanded Use of Medications to Combat Opioid Overdose Epidemic

Vital meds are currently underutilized, report says

Leaders of agencies in the U.S. Department of Health and Human Services (HHS) have outlined a national response to the epidemic of prescription opioid overdose deaths. Their opinions were published in the April 23 issue of the New England Journal of Medicine.

The commentary calls on health care providers to expand their use of medications to treat opioid addiction and to reduce overdose deaths, and describes a number of misperceptions that have limited access to these potentially life-saving medications. The commentary also discusses how medications can be used in combination with behavior therapies to help drug users recover and remain drug-free, and the use of data-driven tracking to monitor a program’s progress.

“When prescribed and monitored properly, medications such as methadone, buprenorphine, or naltrexone are safe and cost-effective components of opioid addiction treatment,” said lead author Nora D. Volkow, MD. “These medications can improve lives and reduce the risk of overdose, yet medication-assisted therapies are markedly underutilized.”

Research has led to several medications that can be used to help treat opioid addiction, including methadone, usually administered in clinics; buprenorphine, which can be given by qualified physicians; and naltrexone, now available in a once-a-month injectable, long-acting form.

The authors stress the value of these medications and describe reasons why treatment services have been slow to use them. The reasons include inadequate provider education and misunderstandings about addiction medications by the public, health care providers, insurers, and patients. For example, one common, long-held misperception is that medication-assisted therapies merely replace one addiction for another — an attitude that is not backed by the science, the article says.

The authors also discuss the importance of naloxone, a potentially life-saving medication that blocks the effects of opioids as a person first shows symptoms of an overdose.

The article describes how HHS agencies are collaborating with public and private stakeholders to expand access to and improve the use of medication-assisted therapies in tandem with other targeted approaches to reducing opioid overdoses. For example, the National Institute on Drug Abuse (NIDA) is funding research to improve access to medication-assisted therapies, to develop new medications for opioid addiction, and to expand access to naloxone by exploring more user-friendly delivery systems (e.g., nasal sprays).

In addition, the Centers for Disease Control and Prevention (CDC) is working with states to implement comprehensive strategies for overdose prevention that include medication-assisted therapies, as well as enhanced surveillance of prescriptions and clinical practices. The CDC is also establishing statewide norms to provide better tools for the medical community in making prescription decisions.

According to the article, the growing availability of prescription opioids has increased the risks for people undergoing treatment for pain and has created an environment and marketplace of diversion, where people who are not seeking these drugs for medical reasons abuse and sell them because they can produce a high.

More than 16,000 people die every year in the U.S. from prescription opioid overdoses — more than the deaths from heroin and cocaine combined. According to the 2012 National Survey on Drug Use and Health, issued by the Substance Abuse and Mental Health Services Administration (SAMHSA), almost 2.1 million people in the U.S. were dependent on or abusing opioid pain relievers.

Sources: NIH; April 24, 2014; and NEJM; April 23, 2014.

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