Five Initiatives That Aim to Address the Opioid Epidemic

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These involve an opioid vaccine, medication take-back programs, local task forces, improving access to naloxone and DEA requirements for e-prescribing.
These involve an opioid vaccine, medication take-back programs, local task forces, improving access to naloxone and DEA requirements for e-prescribing.

The following are 5 initiatives targeted at addressing the opioid epidemic in the United States:

1. Development of a Vaccine Against Opioid Overdose

Researchers from the The Scripps Research Institute have developed a vaccine that blocks oxycodone and hydrocodone-associated analgesia in mice, and that also appears to reduce the risk of death from opioid overdose.1

The vaccine consists in an immunoconjugate of oxycodone or hydrocodone bound to tetanus toxoid, via a modified hapten group. 

It has the advantages of blocking opioid activity without binding the µ-opioid receptors, of eliciting few adverse effects (eg, dysphoria), and remaining in the individual's system for up to a year following initial administration.

While this is not the first vaccine of its kind to be tested, it is the first to be designed with an accurate opioid representation, which makes it highly effective.

Because mice injected with the vaccine took much longer to be affected by opioid toxicity, this may mean that a similar vaccine developed for humans may increase the amount of time responders have to assist those experiencing an overdose.

2. Medication Take-Back Programs May Be Largely Ineffective

Researchers investigating the effectiveness of medication take-back programs found that only about 5% of the drugs collected were controlled medications that can be abused. The other 95% were vitamins and over-the-counter medications.2

The study found that 21 503 units of controlled medications were collected at 3 federal Drug Enforcement Administration-sponsored take-back events and at 5 permanent drop boxes in Kentucky between 2013 and 2014. This represented only 0.3% of the 20 million units prescribed in the state.

Because this study was limited in scope, the results do not necessarily mean that these programs are ineffective. It does mean, however, that further research is called for, and that these programs may not be as effective as many had hoped.

3. Task Force Provides Recommendations for Local Officials to Respond to the Opioid Epidemic

The City-County National Task Force on the Opioid Epidemic has released a report providing recommendations to local officials for dealing with the opioid epidemic. The recommendations focus on “strong leadership, a focus on education and prevention, expansion of treatment, and reassessing public safety and law enforcement approaches.”

“City and county leaders must assume roles of leadership in local efforts to reverse the trends of the opioid crisis,” authors of the report wrote.

The short-hand list of recommendations are:

  1. Set the tone in the local conversation on opioids
  2. Convene community leaders
  3. Foster regional cooperation
  4. Educate and advocate to state and federal partners
  5. Ensure progress for all in formulating responses to addiction

4. Improving Access to Naloxone and Medication-Assisted Therapies 

The Addiction Treatment Advisory Group, which was created in 2015 by the Academy of Managed Care Pharmacy (AMCP), has provided detailed information on addressing the opioid crisis through increased access to naloxone and Medication Assisted Therapies.3

Recommendations for managed care organizations to support patients and improve access to naloxone include:

  • Supporting alternative pain medications and the expertise clinicians need as these alternatives become more widely used
  • Making coverage provisions to provide naloxone to bystanders not at risk of an overdose
  • Co-prescribing naloxone when overdose risk factors are present
  • Making naloxone available on formularies without limits on refills, and considering placing it in a tier that does not prevent patients and bystanders from acquiring it due to expense
  • Increasing naloxone distribution in communities by working with local partners and coalitions; working with hospitals to distribute naloxone through emergency departments

5. DEA Requirements for E-Prescribing Controlled Substances

Electronic prescribing of controlled substances offers the possibility of prescribing medications more efficiently, but also of prescribing potentially dangerous medications such as opioids with increased safety to patients.

The DEA has strict requirements to ensure that the e-prescribing process is up to standard.4

According to Sean P. Kelly, MD, Director of Graduate Medical Education at Beth Israel Deaconess Medical Center in Boston, Massachusetts, “the DEA passed a ruling back in 2010 which allows providers and institutions to prescribe controlled substances electronically, but those requirements are actually quite stringent. Every aspect of the technology needs to be certified by the DEA.”

These aspects include:

  • Pre-enrollment
  • Supervised enrollment of providers
  • The electronic medical record component
  • The e-prescription writing module
  • Authentication software and hardware used to verify that a clinician is actually prescribing a medication
  • Surescripts, the routing of medication to pharmacies
  • The pharmacy's technology platform

 

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References

  1. Kimishima A, Wenthur CJ, Janda KD. An advance in prescription opioid vaccines: overdose mortality reduction and extraordinary alteration of drug half-life. ACS Chem Biol. 2016. doi:10.1021/acschembio.6b00977.
  2. Egan KL, Gregory E, Sparks M, Wolfson M. From dispensed to disposed: evaluating the effectiveness of disposal programs through a comparison with prescription drug monitoring program data. Am J Drug Alcohol Abuse. 2016. doi:10.1080/00952990.2016.1240801.
  3. The role of managed care pharmacy in improving access to naloxone: findings from the AMCP addiction treatment advisory group. AMCP. Available at: http://www.jmcp.org/pb-assets/Outserts/The%20Role%20of%20Managed%20Care%20Pharmacy%20%20-%20Dec%202016.pdf. Accessed December 7, 2016.
  4. Electronic prescriptions for controlled substances . Drug Enforcement Administration. Available at: https://www.deadiversion.usdoj.gov/ecomm/e_rx/. Accessed December 7, 2016.
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