The United States is in the midst of a major public health crisis of untreated opioid addiction. Most policymakers and public health officials understand this, in addition to legislators and the general public.

However, there have also been a number of national reports documenting the significant increase in the use of prescription opioids. The Substance Abuse and Mental Health Services Administration (SAMHSA) has also documented the fact that 80 percent of new heroin addicted individuals report using prescription opioids as a gateway drug.

Answering the problem

There have been a number of effective policy responses to this increasing use and abuse of prescription opioids and heroin in the United States. A number of state legislatures have passed legislation restricting the operation of what have been called “pill mills.”

A good example comes from the Florida legislature, which successfully enacted legislation, which closed many of Florida’s pill mills. Unfortunately, many of the operators of such establishments relocated to other parts of the southeastern corridor.

The second major public policy response has been the implementation of statewide Prescription Data Monitoring Programs (PDMPs), requiring pharmacies to electronically report the dispensing of prescription opioids to a central database. Physicians and other healthcare providers voluntarily access such databases when seeing patients in their practices or hospital settings.

"Eighty percent of new heroin addicted individuals report using prescription opioids as a gateway drug."

Encouraging improvement

While the utilization of such databases has been increasing over the last several years, it is widely seen as an under-utilized service. Accordingly, the White House Office of National Drug Policy (ONDCP) and the Department of Health and Human Services (DHHS) have been encouraging the increased utilization of such PDMP databases by all healthcare professionals and substance abuse treatment programs as a method of better diagnosing and improving access to care for patients in need of such medical attention.

Another important policy response has come from the Food and Drug Administration, requiring pharmaceutical companies, which manufacture prescription opioids, to conduct post marketing surveillance campaigns, where data are gathered to better analyze the changes in the use and abuse of such prescription opioids. There has been an increasing focus on the development of abuse deterrent formulations through such programs as well.

Increasing access to treatment

There are a number of options available to treat chronic opioid addiction in the United States. Unfortunately, there are several major impediments in increasing access to the use of Medication Assisted Treatment for opioid addiction. One impediment relates to the funding of such treatment to either Medicaid or Medicare resources.

At the present time, there are at least 17 states that do not provide any Medicaid reimbursement for the services offered through OTPs. This is a matter that is getting attention and it is hoped that it can be resolved in many of these states. There is also a long-term issue of not siting OTPs where they are needed. This is known at the NIMBY syndrome, or Not In My Back Yard. Many individuals that are part of community groups or town councils will openly acknowledge that there is a major crisis of untreated opioid addiction, but they also voice opposition to the siting of OTPs and other drug treatment services in their own community.

Feeling change

There are also impediments in using such medications as part of the criminal justice system, through correctional facilities, drug courts and probation and parole offices. Of these three groups, drug courts appear to be the most receptive in referring individuals to treatment who appear in their courts.

Without any question, there is a need to effectively coordinate resources at the national, state and municipal levels, responding to the needs of individuals who need access to treatment for their opioid addiction. It took many years to get into this complex issue of untreated opioid addiction and it will also take planning and coordination to get out of this problem. What is required is careful thinking and deliberate action over a sustained period of time.