Opioid epidemic needs a systemic response


Despite years of attention and mounting awareness, the opioid epidemic marches on in communities across the country. The Trump Administration’s recent efforts — from the creation of the Commission Combating Drug Addiction and the Opioid Crisis to Food and Drug Administration Commissioner Scott Gottlieb’s announcement that countering opioid misuse and abuse will be a top priority — demonstrate the urgency and heightened national attention focused on this public health issue. 



These developments, along with the passage of legislation last year — the Comprehensive Addiction and Recovery Act and the Ensuring Patient Access and Effective Drug Enforcement Act — collectively bolster support for prevention, treatment, recovery, as well as enhanced information sharing and effective monitoring among players across the health system.



{mosads}While policymaker leadership is vital, it must also be complemented by a robust effort by each player in the supply chain. Long-term success will require a commitment from those on the front lines to actively engage and work together on preventing addiction and stemming abuse and misuse when it occurs. 



We recognize our industry’s critical role in this effort. As logistics companies who take seriously their responsibility to be part of the solution, primary pharmaceutical distributors have invested heavily in information technology systems to help better flag suspicious prescribing patterns; employed teams of investigators to track and monitor pharmacies they suspect might be engaged in diversion (when medicines are diverted from their intended use); and continue to support efforts designed to improve coordination and communication with the Drug Enforcement Administration. 



Yet, at the root of the challenge we face, lies an important truth: the opioid epidemic has been driven predominantly by prescriptions written by doctors to treat their patients’ pain, the clinical course of action they believed to be most appropriate. The latest report released just last week from the Centers for Disease Control and Prevention (CDC) demonstrates progress, but also confirms the high prevalence of these prescribing patterns across the country. However, that simple fact does not lend itself to simple solutions. The path forward is still complex and requires an honest assessment of the key drivers that led us here in the first place.

The reality that we are all facing today is the delicate balancing act between meeting the legitimate pain management needs of those patients for whom opioids are the best therapy against the very real risk of addiction.

Tens of millions of Americans suffer from chronic pain, and physicians were deluged with requests from those seeking relief. They provided it based on the established medical guidelines and standards of care and in accordance with FDA-approved dosing regimens. In turn, pharmacies were dispensing pills based on legitimate prescriptions and the Drug Enforcement Administration (DEA) continued to approve manufacturers’ requests to increase production of pain medications in response to the demand.



Today, we see greater awareness and self-regulation within the medical community – an important and positive step forward. For example, the American College of Physicians recently announced that opioids should be a “last option” for the treatment of chronic low back pain, and Dartmouth researchers found that surgeons could cut opioid prescriptions in half for their patients when armed with the appropriate knowledge.  

These shifts, coupled with the CDC’s guideline for prescribing opioids for chronic pain are having a meaningful impact. In addition, the DEA is now actively engaged and doing its part to support greater enforcement and monitoring across the supply chain. As Acting DEA Administrator Chuck Rosenberg told Congress last year, “we have a much more robust system to find, investigate, adjudicate, and punish bad behavior.”



While medical societies, regulators, and the public health community have made significant progress, there still is more that can be done. Until recently, healthcare providers have had limited training on identifying or managing addiction.

Moreover, patients and consumers have not been sufficiently educated about the risks of addiction and the importance of proper disposal (especially relevant when 50 percent of abused medicines are obtained from friends and family). Manufacturers also need to continue to pursue the development of less addictive and abuse-deterrent medicines and bring them to market under the watchful eye of the FDA.

All of us in healthcare, without exception, play a role in addressing this epidemic. Such a task cannot fall to one sector alone. We must marshal our collective resources, learn from the past, and look to the future to end the opioid epidemic.

John Gray is the President and CEO of the Healthcare Distribution Alliance, the trade association representing wholesale distributors.

The views expressed by contributors are their own and not the views of The Hill.