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Attempting to Curb the Prescription Opioid Epidemic: Recent News Items of Interest

February 24, 2016 According to the Centers for Disease Control and Prevention (CDC), the number of opioid prescriptions written in the U.S. in 2012 was roughly equal to the number of adults in the population and 46 deaths per day could be attributed to prescription medication overdose.1  Recent news items of interest describe current trends and approaches to the problem of opioid abuse and misuse and potential ways to attempt to curb the prescription opioid epidemic.

*A National Prescription Audit by the information technology firm IMS Health examined the opioid-prescribing patterns of different medical specialties for prescriptions dispensed between the years 2007 to 2012.2  In 2012, U.S. pharmacies and long-term care facilities dispensed 4.2 billion prescriptions, 289 million (6.8%) of which were for opioid analgesics. Although the rate of opioid prescribing generally rose during the period 2007 through 2010, it leveled after that point as most medical specialties reduced opioid use. The largest percentage drops in opioid-prescribing rates occurred in emergency medicine and dentistry; dentists were responsible for 6.4% of opioid prescriptions in 2012, which represented a 5.7% decrease from 2010.  Although the study authors stated that the reasons for stabilization in dispensing of prescription opioids were not fully understood, activities such as “an increase in the use of state prescription drug monitoring programs, changes to pain clinic licensing laws, and adjustments of insurance reimbursement policies, might have reduced inappropriate opioid prescribing.”

*The U.S. Food and Drug Administration (FDA) announced on February 4, 2016 “a far-reaching action plan to reassess the agency’s approach to opioid medications….focus[ing] on policies aimed at reversing the epidemic, while still providing patients in pain access to effective relief.”3  An online FDA “Fact Sheet”4 outlines the FDA’s proposed action steps, including expanding the use of FDA Advisory Committees, strengthening postmarketing requirements and warning/safety information for immediate-release opioids, expanding access to abuse-deterrent formulations of drugs to discourage abuse, and reassessing the risk-benefit approval framework for opioid use. In an op-ed piece in the New England Journal of Medicine,5 Drs. Robert Califf, Janet Woodcock, and Stephen Ostroff describe the FDA’s response as part of a major initiative of the Department of Health and Human Services to “attack the problem from every angle.”

*In a related item, the White House announced on February 2, 2016 that President Obama is proposing $1.1 billion in new Federal funding to address the prescription opioid abuse and heroin use epidemic.6 The funding will “expand access to treatment for prescription drug abuse and heroin use,” and “will boost efforts to help individuals with an opioid use disorder seek treatment, successfully complete treatment, and sustain recovery.”  The ADA has developed a strategic partnership with the White House and the Department of Health and Human Services;7 this partnership will complement the work of the American Medical Association Task Force to Reduce Opioid Abuse, which the ADA joined in August.  

*On February 9, 2016, Walgreens, one of the nation's largest drugstore chains, announced initiatives to be launched addressing prescription drug abuse and misuse and deaths from opioid overdose.8 These initiatives aim to make the opioid reversal agent naloxone (Narcan®) available without prescription in 35 states and Washington, D.C. and to provide dedicated safe medication disposal kiosks in more than 500 drugstores in 39 states and Washington, D.C.

The ADA, in partnership with the American Academy of Addiction Psychology on the Substance Abuse and Mental Health Services Administration Providers’ Clinical Support System for the Opioid Therapies, has provided educational webinars addressing the detection and deterrence of substance use disorders and drug diversion.  In a February 2016 webinar from the ADA Practice Institute, Drs. Cathy Carlson and Aaron Gilson provided an overview of Federal and state policies developed to reduce the transfer of prescription opioid medications from legitimate practice and patient use to illicit use; the presenters recommended that practitioners prescribing opioids give patients a prepared list of appropriate means to dispose of excess pills.  The planned Walgreens dedicated kiosks would provide another option for safe disposal of all unneeded prescription drugs, including pain medications.

By the end of 2016, Walgreens plans to install safe medication disposal kiosks at more than 500 drugstores in the following states:

Alabama, Arizona, Arkansas, California, Colorado, Connecticut, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Virginia, Washington, Wisconsin (State-specific regulations prevent Walgreens from installing safe medication disposal kiosks at this time in certain states)

Also by the end of 2016, Walgreens will make naloxone available without a prescription at its pharmacies in the following states:

Alabama, Arkansas, California, Colorado, Connecticut, District of Columbia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Wisconsin (Montana and South Dakota only allow naloxone to be dispensed without a prescription to the patient)

References

  1. Centers for Disease Control and Prevention (CDC). CDC VitalSigns: Opioid Painkiller Prescribing. U.S. Department of Health and Human Services. http://www.cdc.gov/vitalsigns/opioid-prescribing/. Accessed February 11, 2016.
  2. Levy B, Paulozzi L, Mack KA, Jones CM. Trends in Opioid Analgesic-Prescribing Rates by Specialty, U.S., 2007-2012. Am J Prev Med 2015;49(3):409-13.
  3. U.S. Food and Drug Administration. News Release: Califf, FDA top officials call for sweeping review of agency opioids policies. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm484765.htm. Accessed February 11, 2016.
  4. U.S. Food and Drug Administration. Fact Sheet: FDA Opioids Action Plan. http://www.fda.gov/NewsEvents/Newsroom/FactSheets/ucm484714.htm. Accessed February 11, 2016.
  5. Califf RM, Woodcock J, Ostroff S. A Proactive Response to Prescription Opioid Abuse. N Engl J Med 2016.
  6. Office of the Press Secretary. Fact Sheet: President Obama Proposes $1.1 Billion in New Funding to Address the Prescription Opioid Abuse and Heroin Use Epidemic. The White House 2016. https://www.whitehouse.gov/the-press-office/2016/02/02/president-obama-proposes-11-billion-new-funding-address-prescription. Accessed February 11, 2016.
  7. American Dental Association. ADA News: ADA, White House Partner on Opioid Abuse Prevention Initiative.  October 21, 2015. http://www.ada.org/en/press-room/news-releases/2015-archive/october/ada-and-white-house-partner-on-opioid-abuse-prevention-initiative. Accessed February 24, 2016.
  8. Walgreens Inc. News Release: Walgreens Leads Fight Against Prescription Drug Abuse with New Programs to Help Curb Misuse of Medications and the Rise in Overdose Deaths (02/09/16). http://news.walgreens.com/press-releases/general-news/walgreens-leads-fight-against-prescription-drug-abuse-with-new-programs-to-help-curb-misuse-of-medications-and-the-rise-in-overdose-deaths.htm. Accessed February 11, 2016.

ADA Resources

ADA News: ADA, White House Partner on Opioid Abuse Prevention Initiative
ADA Catalog:  The ADA Practical Guide to Substance Use Disorders and Safe Prescribing (Item #P035)

Prepared by: Center for Scientific Information, ADA Science Institute

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Science in the News is a service by the American Dental Association (ADA) to its members to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.

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