In this Daily Dose, we have assembled a trio of stories on the evolving response to the public health crisis of prescription medication abuse, misuse, and diversion. An expert review appearing in the Journal of Psychiatric Practice outlines strategies for expanding access to buprenorphine for the treatment of opioid and heroin addiction, while recognizing its own potential for abuse and diversion. The authors comment: “The question is not whether or not to expand buprenorphine prescribing. It is how to expand buprenorphine prescribing safely and effectively.” A news story about the paper, with link to the full journal article, may be read here.
The impact of a further complication associated with opioid abuse—that of infection—is explored in a new study conducted by clinicians from Beth Israel Deaconess Medical Center (BIDMC) and the VA Boston Healthcare System. Examining discharge data from a representative sample of inpatient hospitalizations in the US between 2002 and 2012, the study found a 91% increase in admissions for opioid abuse and serious infection. The cost impact of infection-related hospitalizations is enormous; compared to a charge per hospitalization of $28,000 for opioid abuse alone, the cost per hospitalization for abuse and associated infection was over $107,000. The findings appear in this month’s issue of the journal Health Affairs; a news story may be read here.
Finally, we call attention to this article appearing in the May 2 edition of The New York Times detailing the FDA’s decision to revisit the question of mandatory education for all prescribers of opioid medications. In 2012, FDA approved a risk evaluation and mitigation strategy (REMS) for extended-release and long acting opioids that included access to voluntary education on safe prescribing, but declined to make this training compulsory. Now in the face of escalating pressure, and support for mandatory education from the White House, other government agencies, and even medication manufacturers, a new FDA advisory panel has unanimously recommended that prescriber education be made mandatory. At a 2-day joint meeting last week, the FDA’s Drug Safety and Risk Management Advisory Committee and its Anesthetic and Analgesic Drug Products Advisory Committee voted to recommend that the training be mandatory and include IR drugs. It was additionally suggested that it also focus on pain management rather than on opioids, be tied to the recently released Centers for Disease Control and Prevention (CDC) guidelines, and involve mental health and suicide screening.
To access the painweek.org library of information on opioids, tap here.