Can Legislation End Addiction?

It’s going to be an action-packed week in the world of opioid legislation — or so they say. Several regulations are up for consideration as part of what many are dubbing “Opioid Week.”

House Majority Leader Kevin McCarthy (R-Ca.) has said the week of May 9, when the House returns from a week-long recess, will be “Opioid Week.” Energy and Commerce Committee Chairman Fred Upton (R-Mich.) expects bills from various committees to be brought up on the floor individually.

In March, the Senate passed the Comprehensive Addiction and Recovery Act by a 94-1 vote. It would provide nearly $80 million for drug abuse treatment and prevention programs and increase the availability of the drug Naloxone to treat overdoses.

Three House committees voted to advance more than a dozen opioid bills to the House floor as well. The measures would authorize funding for state and local treatment program grants. They would also drive a review of existing laws and adjust the number of patients that physicians can treat in a given year for opioid abuse.

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The Comprehensive Opioid Abuse Reduction Act (H.R. 5046), passed by the House Judiciary Committee, is set up to accomplish the same goals as CARA, according to Rep. John Conyers (D-Mich.).

Proposed legislation, including CARA, contains many promising reforms, Dr. Arthur Robin Williams, a psychiatrist and research physician at Columbia University Medical Center in New York City, said. Few policymakers realize the extent to which insurance policies restrict access to life-saving medications such as methadone, buprenorphine, and naltrexone.

“More needs to be done to increase affordable access to medication,” he said.

Better Training: Solution or Stall?
On Wednesday, 30 advisers supported Food and Drug Administration advisory committees that recommend mandatory training for physicians who prescribe opioids. Not everyone is on board with it—industry and doctor groups have been vocal in their opposition.

[lz_bulleted_list title=”What Are Opioids?”]Hydrocodone (e.g., Vicodin)|Oxycodone (e.g., OxyContin, Percocet)|Morphine (e.g., Kadian, Avinza)|Codeine[/lz_bulleted_list]

The advisers also said the FDA should broaden its oversight of fast-acting drugs like Percocet and Vicodin — not just extended-release drugs that are thought to be more dangerous.

Doctors may be resistant to mandatory training, said Williams, but they must look at the rise in opioid-related deaths.

“At some point, organized medicine must be held accountable for its role in stemming the epidemic and reining in [the] over-prescribing of a class of medications for an indication [like chronic pain] for which there is a very weak evidence base for benefit and known risks and harms,” he said.

Dr. Thomas Kosten, director of the division of alcohol and addiction psychiatry at the Baylor College of Medicine, said that he supports more training for medical students and a required continuing medical education course on the topic.

Mandatory training will be another “fantastic distraction” that won’t address the real problems, said Dr. Carl L. Hart, a professor of psychology at Columbia University.

Hart said many doctors are already doing a great job of being cautious in prescribing painkillers, though a few have been irresponsible.

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“The proposed training will not address these concerns,” he said. “It will, however, place an additional burden on physicians. This will, in turn, decrease the number of physicians willing to prescribe these medications — making it more difficult for patients to obtain opioids when medically indicated.”

Hart noted that combining opioids with another sedative such as alcohol or a benzodiazepine causes the vast majority of these deaths. “Public service announcement campaigns are needed with a clear message: Don’t combine opioids with other sedatives.”

Hart said the dose of acetaminophen in popular painkillers such as Percocet and Vicodin can cause acute liver failure — another reason opioids can be harmful. Some individuals, seeking a heroin-like high, unwittingly risk liver damage by taking too many of these pills, he explained.

“The problem here is not the opioid. It’s the acetaminophen. Acetaminophen should be removed from opioid formulations,” Hart said. “In the meantime, users need to aware of this potential fatal outcome.”

A new poll from the Kaiser Family Foundation shows roughly two-thirds of the public thinks the government is not doing enough about the epidemic. Over 80 percent of people said increased prescription training for doctors, more access to treatment programs, and monitoring doctors’ prescribing practices would be effective in fighting the epidemic. Forty-four percent of the public said they know someone who has been addicted to prescription painkillers.

A study in the journal Health Affairs found that the cost of prescription painkillers has been decreasing for most patients over the last decade — a growing portion of costs are covered by insurers. This could be partly responsible for the surge in opioid use.