White House Expands Opioid Addiction Response
President Barack Obama this afternoon visited Charleston, West Virginia, to listen to local concerns about the epidemic of opioid abuse and death and to announce new federal efforts to address the problem.
West Virginia's overall drug overdose death rate during 2011–13 was about 34 per 100,000 population—the highest rate in the nation, according to a June report from the Trust for America's Health and the Robert Wood Johnson Foundation. The figure includes deaths attributed to the misuse and abuse of opioid drugs, including prescription medications and heroin.
"We've been hit harder than any other state," said West Virginia Senator Joe Manchin.
Manchin said 600 West Virginians have died from drug overdoses each year between 1999 and 2010.
Overdose deaths attributed to heroin in West Virginia, which is home to about 1.85 million people, have risen dramatically, from 5 deaths during 2003 to 140 during 2013, according to the state's department of health.
Obama said that when he came into office, he was "stunned" by national statistics about drug overdose deaths.
"More Americans now die every year from drug overdoses than they do from motor vehicle crashes," Obama said. "In 2013 alone, overdoses from prescription pain medications killed more than 16,000 Americans."
Nationally, according to federal data, overdose deaths related to prescription opioids leveled off around 2012, but deaths from heroin use have been climbing since 2010. Data suggest that efforts to restrict the inappropriate use of prescription opioids have led to the increase in heroin use.
"Four in five heroin users—new heroin users—started out by misusing prescription drugs, then they switched to heroin," Obama said. "The prescription dugs become a gateway to heroin."
Michael Boticelli, director of the White House Office of National Drug Policy, said during a media telebriefing this morning that "we cannot separate the heroin epidemic from the prescription drug use epidemic" because they are different faces of the same problem.
The Obama administration's response to the epidemic includes a White House memorandum, released today, directing federal agencies to ensure that employees who are involved in the prescribing of controlled substances complete, within 18 months, training related to the appropriate use of the drugs.
"Many physicians [say] that they receive little to no training on safe and effective opioid prescribing," Boticelli noted.
The newly mandated training must address best practices for the appropriate and effective prescribing of pain medications; the misuse potential of controlled substances; the identification of substance-abuse disorders and referral of patients for evaluation and treatment; and safe disposal methods for controlled substances.
Certain federal contractors, residents, and clinical trainees associated with federal agencies are also subject to the directives in the memorandum.
The federal mandate is meant to serve as a model for other educational efforts. According to the White House press office, state, local, and private entities have given support to the federal effort by agreeing to provide training in the prescribing of opioids to more than 540,000 healthcare providers over the next two years.
ASHP was an invited participant at the event and committed to offering education and resources to over 40,000 pharmacists, student pharmacists, and pharmacy technicians.
Boticelli said the White House has also directed the Department of Health and Human Services to "undertake a review of how pain management is evaluated by pain satisfaction surveys used by hospitals and other care providers."
"We want to make sure that there is nothing in our own federally mandated survey that might have the unintended consequence of promoting prescription pain medications," Boticelli said.
Hospitals that participate in the Medicare program are required to publicly report patient satisfaction with inpatient pain management as part of the Hospital Consumer Assessment of Healthcare Providers and Systems survey.
The White House initiative also seeks to double the number of healthcare providers that prescribe naloxone.
Many states in recent years have considered or passed laws intended to increase the likelihood that naloxone will be on hand when a person overdoses from heroin or prescription opioids.
Boticelli also touted the success of "National Take Back Days" spearheaded by the Drug Enforcement Administration (DEA). These events, held since 2010, have resulted in the collection of more than 5.5 million pounds of unused, unwanted, and expired medications, including prescription opioids.
"We know that 70% of those who start misusing prescription pain medications get them free from friends and families, often from their very own homes or other peoples' homes. So getting unwanted or unused meds out of peoples homes has been a clear priority for this administration," Boticelli said.
DEA in September 2014 released regulations intended to replace the federal take-back event with permanent programs in hospitals, pharmacies, and other sites. But the agency later reinstated its take-back programs, the most recent of which was held September 26, 2015.
The White House stated that additional two additional take-back days will be held next year.
[This news story appears in the January 1, 2016, issue of AJHP.]