Although the Trump administration correctly drew national attention to the opioid crisis by naming it a public health emergency, not enough to combat opioid-related harms seen every day in the United States, according to a viewpoint published in JAMA Psychiatry.
The absence of funds remains crucial to address the epidemic’s emergency components.
“A recent Congressional infusion of $6 billion across 2 years can begin to triage opioid emergencies if the funds are allocated toward these purposes,” Rebecca L. Haffajee, JD, PhD, MPH, department of health management and policy, University of Michigan School of Public Health, and Richard G. Frank, PhD, department of health care policy, Harvard Medical School, wrote. “However, the epidemic, whose burden cost the United States $115 billion in 2017 and is projected to cost $200 billion by 2020, requires much greater funds, quickly.”
In their viewpoint, Haffajee and Frank propose that opioid-related “emergencies” meet the criteria for a public health emergency, including:
- the skyrocketing rate of opioid-related mortality;
- the recent increase in HIV and hepatitis C transmissions;
- the rising number of children in foster care; and
- the absence of evidence-based opioid use disorder treatment or medication-assisted therapy (MAT).
Although increasing access to naloxone hydrochloride would help prevent opioid-related mortality, the dose required to reverse opioid-related overdoses is at least times greater than what is usually available, according to Haffajee and Frank. Funding devoted toward naloxone hasnt increased between 2017 to 2018; if ongress appropriated money into the public health emergency fund, it could improve access to, and training in administering, naloxone.
Using clean syringes and enrolling people in supervised syringe exchange programs has been proven to reduce infectious disease transmission, the authors explained. They recommend the federal government promote the use of clean syringes using rapid appropriations.
“Providing the 700,000 persons with heroin use disorders who are potentially using it via injection with needle exchange access at a price of about $20 per person would cost $14 million,” Haffajee and Frank wrote. “Alongside funding, the Department of Justice could indicate that it will not prosecute Controlled Substances Act crimes of being in possession of illicit drugs at needle exchange programs.”
With the number of children in foster care on the rise, largely due to parents’ opioid-related overdoses, interventions should focus on using naloxone and providing more MAT, the authors wrote. They advise money from the public health emergency fund or federal supplemental grants be used for state foster care systems. Clinical evidence has shown that MAT can help prevent opioid-related overdoses, deaths and infectious disease transmissions, which is especially needed in rural communities.
Haffajee and Frank suggest that, along with declaring the opioid epidemic a public health emergency, President Donald J. Trump declare a national emergency under the Robert T. Stafford Disaster Relief and Emergency Assistance Act or the National Emergencies Act. If this happens, the HHS could help “facilitate MAT by relaxing the Drug Addiction Treatment Act of 2000 waiver requirements for buprenorphine prescribing and waiving the consent requirements of 42 CFR Part 2 (Confidentiality of Substance Use Disorder Patient Records) when disclosure of certain substance use treatment program records pertains to coordinating other addiction-related treatment.”
Other strategies include implementing public health personnel to provide MAT and enabling telemedicine clinicians to prescribe buprenorphine without doing an in-person examination.
“The magnitude of current appropriations is small relative to the epidemic’s costs,” the authors wrote. “Although many longer-term actions—including prescriber education, pain therapy alternatives, heightened oversight of illicit opioids, and robust addiction therapy—are needed, emergency steps can and should be taken to address the opioid-related imminent harms.” – by Savannah Demko
Disclosures: The authors report no relevant financial disclosures.