Confronting the National Opioid Crisis
A Multipart Series
A Call to Action
The federal response to the opioid issue intensified when then-Acting Secretary of the Department of Health and Human Services (HHS) Eric D. Hargan classified the crisis as a public health emergency in October 2017. The declaration, which was included in recommendations from the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, largely permitted the administration to use government resources to take expedited actions to address the situation. HHS and the Office of the Surgeon General reaffirmed the administration’s commitment to equip stakeholders with tools, resources and information to change the trajectory of the crisis in the United States. Following the Senate confirmation of James Carroll as director of the Office of National Drug Control Policy in January, the administration released its National Drug Control Strategy, which focuses on reducing the size of the drug-using population, reducing barriers to treatment services for those suffering from substance use disorder and reducing the availability of illicit drugs.
Recognizing the proliferation of opioids in communities, the Surgeon General released Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health in 2016. The report, updated in 2018 as Facing Addiction in America: Spotlight on Opioids, was the first by the Surgeon General that focused solely on substance use and addiction. That office also released a public health advisory urging Americans to be aware of how to use naloxone and to keep it within reach if they or a family member meet the criteria for being at risk for an opioid overdose.
The HHS response is organized around a five-point strategy:
1. Better addiction prevention, treatment and recovery services. A centerpiece of HHS’s response to the crisis is the Opioid State Targeted Response (STR) grant program, through which $1 billion in funding has been allocated to states. The Opioid-STR program was authorized by the 21st Century Cures Act and is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). Intended to supplement existing activities within states, it supports needs assessment; strategic planning; analysis of statewide gaps and resources; and expanded evidence-based treatment practices, particularly medication-assisted treatment and recovery support services, for target populations. STR recipients are encouraged to coordinate prevention efforts with those funded by other federal entities, such as the Centers for Disease Control and Prevention (CDC). Pharmacy schools have received STR grants to promote education, naloxone distribution and protocols and addiction medicine consultation in clinic.
2. Better data. HHS recognizes that state and federal response has been hampered by outdated and incomplete information on adverse events related to opioid use, such as missing information on the specific drug involved for many overdose deaths. In 2018, the CDC released Opioid Overdoses Treated in Emergency Departments and the 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes in the United States. The CDC now also reports provisional data on overdose deaths monthly and has awarded states funding to support their surveillance efforts of opioid-involved morbidity and mortality and prescription drug overdose prevention. The Agency for Healthcare Research and Quality (AHRQ) is using data from the Healthcare Cost and Utilization Project to build an interactive “Fast Stats” tool containing patient data and geographic information about opioid-related hospitalizations, to enable research to advance evidence-based response to the crisis.
3. Better pain management. The National Pain Strategy is meant to serve as a guide toward achieving a system in which everyone receives appropriate, high-quality and evidence-based pain management. The strategy encompasses professional education and training, public education, disparities, payment and care, services and payment and population research. Implementation is overseen by working groups of the Interagency Pain Research Coordinating Committee, which also coordinates the Federal Pain Research Strategy in conjunction with the National Institutes of Health. NIH also funds the Centers of Excellence in Pain Education at 11 academic institutions. These serve as centers for developing, evaluating and distributing curriculum resources focused on pain. Resources are available to pharmacy, medical, nursing and other health professional schools.
4. Better targeting of overdose-reversing drugs. SAMHSA joined with the Health Resources and Services Administration to provide funding to expand the availability of overdose-reversal medications in healthcare settings and support poison control centers in their efforts to provide treatment from misuse of prescription and illicit opioids. AHRQ has funded grants to study how naloxone can be distributed through communities, including in the pharmacy setting.
5. Better research. In 2018, NIH launched the HEAL (Helping to End Addiction Long-term) Initiative, a trans-agency effort to transition scientific understanding gained from NIH research into effective solutions to the opioid crisis. This research encompasses understanding of the neurological basis of pain and addiction and alternative treatments for pain as well as studying treatment models for opioid use disorder and new forms of medication-assisted treatment. Nasal naloxone for overdose reversal, buprenorphine for treating opioid use disorder and studies showing the equivalence of buprenorphine and naltrexone all originated with NIH support. The HEAL Initiative Research Plan aims to improve prevention and treatment and enhance pain management. Funding opportunities so far have covered longitudinal study of antenatal opioid exposure, back pain, prevention strategies, new technologies to treat pain and addiction and the Justice Community Opioid Innovation Network. This network is a collaboration between NIH and community partners that will study how the criminal justice system can more effectively respond to the crisis.