Report Offers Evidence-Based Recommendations to End Prescription Opioid Abuse

A research team led by Johns Hopkins Bloomberg School of Public Health investigators has issued a report to help tackle the prescription opioid epidemic that kills an average of 44 people per day in the United States.

Stemming from discussions at a town hall meeting co-hosted by the Bloomberg School and the Clinton Health Matters Initiative, an initiative of the Clinton Foundation, the report recommends changes in the following:

• How medical students and physicians are trained. The report calls for more comprehensive training of medical students, who currently receive little instruction on opioid-related matters.
• How prescriptions are dispensed and monitored. The report calls for stricter oversight of clinical prescribing. Expansion of pharmacy and pharmacy benefits manager roles are recommended, as both stand between prescribers and patients. Pharmacies could increase their role in reducing opioid misuse and abuse through the use of electronic prescribing to identify high-risk patients and prescribers as well as through expanded availability of drug take-back programs that allow patients to return unused medication to pharmacies to reduce chances that the pills might be taken by potential abusers.
• How first responders are equipped to treat overdoses
• How those with addiction are identified and treated. The report calls for providing funding for treatment programs in communities with high rates of addiction, as well as educating prescribers and pharmacists on how to prevent addiction.

Recommendations were developed with the input of professionals from medicine, pharmacy, injury prevention, law, insurance, and patient representatives.

“What’s important about these recommendations is that they cover the entire supply chain, from training doctors to working with pharmacies and the pharmaceuticals themselves, as well as reducing demand by mobilizing communities and treating people addicted to opioids,” said Andrea Gielen, ScD, ScM, director of the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School and one of the report's signatories. “Not only are the recommendations comprehensive, they were developed with input from a wide range of stakeholders, and wherever possible draw from evidence-based research.”

The report comes at an opportune time, as opioid doses are at an all-time high. According to the Centers for Disease Control and Prevention (CDC), opioid overdose-related deaths grew four times between 1999 and 2013, up to 16,000. During the same period, prescription opioid sales increased 300%. The CDC estimated that 2 million Americans were dependent on opioids in 2013. In 2012, 259 million prescriptions were written for opioids, enough to supply every American adult with a non-stop, 4-weeks supply, according to the CDC.

Titled “The Prescription Opioid Epidemic: An Evidence-Based Approach,” the report includes seven sections of recommendations:

• Prescribing Guidelines
• Prescription Drug Monitoring Programs (PDMPs)
• Pharmacy Benefit Managers and Pharmacies
• Engineering Strategies (eg, packaging)
• Overdose Education and Naloxone Distribution Programs
• Addiction Treatment
• Community-Based Prevention Strategies

In regard to PDMPs—state databases including controlled substance prescriptions from in-state pharmacies—the report authors call for mandatory use, as PDMPs are voluntary in many states and actual use and designs vary from state to state. The report also recommends that PDMPs be more accessible to law enforcement as warranted.

Other recommendations include expanding the availability of naloxone—a medication shown to reverse the effects of an opioid overdose when administered promptly—and the development of more secure and tamper-resistance packaging through design contests and other approaches.

“This is a complex epidemic with no simple solutions,” said G. Caleb Alexander, MD, MS, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness at the Bloomberg School and another of the report’s signatories. “We tried to identify as many windows as possible and to tie together as much research as available to inform these recommendations, which together we believe provide the best chance of turning this steamship around.”