Orthopedists Due Major Blame for Opioid Crisis? – PART II

5. Drug company publicists blame physicians.

Despite the numbers, a prescription drug manufacturers’ trade association, the “Healthcare Distribution Alliance,” put up a web page in June titled; “Fact Check: Where 60 Minutes Got it Wrong on the Opioid Crisis” disputing the findings of Washington Post-60 Minutes reports.

It says: “FACT: There is broad recognition among leading public health authorities that opioids have been over-prescribed—a trend that began in the 1990s and has only recently received the attention it deserves.”

This bold piece of propaganda, just a few weeks ago, comes despite the 22% decline in the total of opioid prescriptions written from 2012 to 2016, while the use and availability of illicit pills has continued to rise.

6. Expect new, alternative pain medications – several years from now.

A 2016 law signed by President Obama directed the National Institutes of Health (NIH) to fund research on alternatives to opioids for pain medication.

NIH announced in April 2018 that it will be offering grant money for that research. So, eight or ten years down the road, given the time it takes for testing and clinical trials, there might be new, affordable, effective alternatives to opioids for pain. Or maybe not. If there are, the next question is whether their costs will be covered by Medicare, Medicaid, and private insurance (or whatever sort of a health system we’ll have then).

Most of the current, effective alternatives for chronic pain (other than NSAIDs) require physician intervention, and are therefore costlier, and they may or may not be covered by health insurance.

The wording of the 2016 legislation and the NIH announcement appear to be aimed at finding cheap and easy treatments—that is, non-addictive pills which would work better than NSAIDs.

7. Will effective treatments for opioid abuse be covered by insurance, Medicaid, and Medicare? And will drug prices be capped?

Treating opioid abuse or overdoses isn’t generally part of the orthopedic specialty, except to the extent that drugs which reduce the risk of addiction or overdose are sometimes prescribed along with opioids to prevent opioid use disorder (OUD) these days—a new regimen in the past couple of years.

Effective treatments which reduce the risk of either fatal overdoses or long-term dependency are available. They’re called medically assisted treatments (MAT). The issues are, as they have ever been, whether they’ll be covered by insurers or not.

The price of an overdose treatment, a ready-made injector called Evizio, which is similar to an Epipen, went from $690 per 2-dose pack in 2014 to $4,500 in 2016. A nasal inhaler of the same drug (Naxolone) costs $150. And multiple treatments might be needed. Naxolone itself is fairly cheap, and in some states, it’s available in a kit at pharmacies without a prescription.

The cost issues for addiction treatment are different. Medically assisted treatment (MAT) requires therapy, lab testing, and lengthy prescriptions for long-acting drugs which prevent euphoria and allow for gradual withdrawal (a buprenorphine/naloxone combination or extended-release naltrexone, according to a National Institute on Drug Abuse (NIDA) study).

It’s expensive, but it works. The NIDA said that after buprenorphine was made available in Baltimore, overdose deaths fell 37%. An interesting fact about buprenorphine, the NIDA says on its website, is that it is sometimes illegally diverted—to drug abusers trying to heal their addiction.

Fewer than half of all the substance abuse treatment centers in the U.S. use MAT, and of those, only a third of opioid addicts are receiving MAT. – “Effective Treatments for Opioid Addiction.”