House Members Consider Best Options for Treatment, Prevention of Opioid Abuse

According to the National Institute on Drug Abuse, overdose deaths from opioid pain relievers and heroin increased by an average of 400 percent from 2001 to 2013. In April, experts in addiction psychiatry testified before members of the U.S. House of Representatives on the growing health concern of opioid misuse in the United States and common misperceptions about factors driving this trend.

“Let me state clearly so as to leave no room for doubt,” said Rep. Tim Murphy (R-Pa.), the chair of the U.S. House Energy and Commerce Subcommittee on Oversight and Investigations. “Our current strategies are failing, and I am not going to stop until we start moving in the direction of success defined not just as getting individuals off of street drugs and onto a government-approved opioid, but getting them to the point of drug-free living.”

The hearing included perspectives from leading experts in opioid addiction, who discussed the best options for treatment and prevention, including medication-assisted treatment and prescription drug–monitoring programs.

“Unlike many other disorders with high mortality rates, opioid use disorder is treatable, and a joint effort of health professionals, community advocates, and policymakers is urgently needed to reverse this tragic trend,” testified Adam Bisaga, M.D., a professor of psychiatry at Columbia University School of Medicine.

The scientific evidence in favor of medication-assisted treatment as part of an overall strategy to fight opioid addiction was highlighted by several members of the expert witness panel. “Opioid-addicted people need access to a broad range of treatments for opioid addiction,” said Laurence Westreich, M.D., president of the American Academy of Addiction Psychiatry.

Currently, three medications are widely used in the treatment of opioid dependence: methadone, buprenorphine, and naltrexone. Westreich emphasized that prescribing the appropriate effective medication to help a patient with opioid-related withdrawal along with psychotherapy for co-occurring psychiatric disorders, such as depression and posttraumatic stress disorder gives a patient the best chance for recovery.

“I fully recognize the importance of medication-assisted treatment as a transition from street drugs and to prevent overdose from heroin,” Murphy remarked, “but relying on this as the one and only solution shouldn’t be the strategy.”

Anna Lembke, M.D., an assistant professor of psychiatry and behavioral sciences at Stanford University Medical Center, said that opioid misuse is just one part of a greater problem. “We also have an opioid overprescribing epidemic,” she explained.

According to research performed by CVS/Caremark, prescription rates for opioid painkillers jumped 300 percent between 1999 and 2010. “Contrary to what is commonly believed, doctors who treat addiction are not the source of the problem,” Lembke said. “The methadone that accounts for 40 percent of deaths by a single-drug opioid pain reliever is almost entirely in the form of pills prescribed for the treatment of pain, rather than coming from methadone maintenance clinics that treat individuals who are heroin dependent. Thus, it’s very important that we not only scrutinize physicians who prescribe opiates for the treatment of addiction, but also those physicians who treat other common chronic illnesses such as pain.”

Other topics discussed during the hearing included the combined use of scientific and spiritual intervention and the use of naloxone as a first response to reverse opioid overdose.

“One of the most promising interventions has been new laws focused on overdose prevention, increased access to naloxone, Good Samaritan protections, and treatment of opioid use disorders,” testified AMA Secretary of the Board of Trustees Patrice Harris, M.D., M.A., the director of the Fulton County Department of Health and Human Services. “The AMA has worked hand-in-hand with many state medical societies to help enact these laws throughout the nation, and our goal is for every state in the land to support this life-saving approach.”

After the testimonies, Murphy told Psychiatric News that the hearing was an eye opener. “A lot of Americans who need treatment for opioid addiction are not getting the needed treatment. We need more providers to treat addiction and more regulation of the prescription practices that involve opiates,” he said. “The subcommittee is definitely going to take the recommendations that were made today into consideration in hopes of bringing about change.” ■