While the tragic consequences of the opioid epidemic continue unabated, Federal efforts to address this issue have been put on hold. Fortunately, individual states, led by their governors, are stepping into the vacuum.
To protect patients in physical pain from developing addictions to their medications, the CDC Guideline for Prescribing Opioids for Chronic Pain is being applied to address the overprescribing patterns of some physicians. This being done on a voluntary basis by some states while others, such as Massachusetts, have made the Guideline mandatory. For those already addicted, access to treatment is being emphasized. Concern about this was one of the issues that led to the defeat of the Senate healthcare bill. At their summer conference, the governors also looked at the importance of focusing on follow up treatment after overdose survival as well as the need to continue to work on reducing persistent stigma faced by individuals with substance use disorders.
On a Federal level, the momentum of effective interventions had been building before the Trump administration took over in January. On March 29, however, rather than continue to implement these bipartisan and non-controversial interventions in view of the urgency of the opioid problem, the Administration created the President’s Commission on Combating Drug Addiction and the Opioid Crisis to study the problem yet again. Enough is already known about what interventions would be useful for actions to be implemented without further delay. The Federal government had recently published the Surgeon General’s report, “Facing Addiction in America” – an exhaustive analysis with recommendations for action.
The first meeting of the Commission was held on June 16. Reassurances are being made about the progress it is making, but the Commission already missed its June 27 deadline for issuing its initial interim report. The next meeting will be by teleconference on Monday, July 31, 2017, at 4:00 p.m. Eastern time to review the Commission’s draft interim report.
Delays in other areas exacerbate the negative effect of the delay created by waiting for the recommendations of the Commission. Key leadership positions remain unfilled. A permanent “drug czar” to head the ONDCP has not yet been appointed. The unusual dismissal of Vivek Murthy, a Surgeon General who focused on addiction problems, left another vacuum. On a hopeful note, his proposed replacement, Dr. Jerome Adams, relinquished his own biases against needle exchange programs and convinced then Indiana Governor Mike Pence to adopt this approach to stem an outbreak of HIV/AIDS in that state. The replacement of ideology with evidence-based interventions is always welcome. I look forward to hearing more from Dr. Adams.