Story at a glance
- Tens of millions of Americans are prescribed opioids like hydrocodone, oxycodone and fentanyl each year to treat moderate to severe pain for patients following surgery or injury.
- But the powerful drugs run the risks of addiction, abuse and overdose.
- A bipartisan group of lawmakers in Congress is trying to slash the number of opioids prescribed to patients with the Non-Opioids Prevent Addiction in the Nation Act, or the NOPAIN Act.
As drug overdose deaths in the U.S. continue to skyrocket, advocates and lawmakers are working to pass key legislation to help prevent opioid addiction before it starts.
Tens of millions of Americans are prescribed opioids like hydrocodone, oxycodone and fentanyl each year to treat moderate to severe pain for patients following surgery or injury. But the powerful drugs run the risks of addiction, abuse and overdose.
Up to 29 percent of people who take prescription opioids misuse them, and 3 million Americans have had or currently suffer from an opioid use disorder. The overwhelming majority of heroin users report misusing prescription opioids before starting heroin use.
With nearly 108,000 overdose deaths reported nationwide in 2021 alone, a bipartisan group of lawmakers in Congress is trying to slash the number of opioids prescribed to patients with the Non-Opioids Prevent Addiction in the Nation Act, or the NOPAIN Act.
Sens. Rob Portman (R-Ohio), Jeanne Shaheen (D-N.H.), Shelley Moore Capito (R-W.Va.) and Joe Manchin (D-W.Va.) introduced the NOPAIN Act in the Senate in March 2021. In the House, the legislation was introduced by Reps. Terri Sewell (D-Ala.), David McKinley (R-W.Va.), Ann Kuster (D-N.H.) and Brian Fitzpatrick (R-Pa.) two months later in May 2021.
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The measure would expand access to Food and Drug Administration-approved, non-opioid pain management treatments, such as nerve block injections, to those enrolled in Medicare who undergo an outpatient surgery.
Currently, Medicare does not provide a separate reimbursement for these alternative treatments like it does for prescription drugs, creating what advocates call an “inadvertent” incentive for physicians to prescribe opioids. The NOPAIN Act would remedy the “outdated federal reimbursement policies” by directing the Centers for Medicare and Medicaid Services to provide a separate reimbursement for non-opioid treatments used to manage pain.
“A lot of attention in Congress and in previous administrations has been focused on the opioid crisis in this country, however, relatively little of that attention has focused on opportunities to prevent opioid addiction before it begins,” Chris Fox, executive director of Voices for Non-Opioid Choices, a group rallying support for the bill, told Changing America.
“We know that for many, the path toward opioid use can start after being exposed to a prescription opioid, which can start after a surgical procedure. The vast majority of surgery patients in this country have their pain treated via prescription opioid pills despite the availability of other safe and effective non-opioid pain therapies that are out there,” Fox said.
Alternatives include a multimodal approach, utilizing a combination of medications from different drug classes to control acute pain effectively, including long-acting nerve blocks and nonsteroidal anti-inflammatory drugs administered through an IV, among others.
“The Non-Opioids Prevent Addiction in the Nation Act would create a level ball field. It would say that we’re going to put all pain treatment options on the table,” Fox said.
The bill has robust support in Congress, with more than 135 members of both chambers backing the measure, including nearly 50 percent of the Senate. Major medical associations, including the American Medical Association, and leading patient and recovery groups have also endorsed the legislation.
Among the groups of supporters is the Will Bright Foundation, a nonprofit based in Alabama that operates a transitional next step living facility for those exiting rehab and advocates for families with loved ones struggling with addiction issues.
Lisa Bright, the group’s founder, started the nonprofit in 2014, just two years after her 25-year-old son Will Bright died from a heroin overdose.
“Will was the baby of the family so he was a happy kid who played sports, Cub Scouts, enjoyed wrestling and football, and was active in church activities. Pretty much just a normal type of child. He got into those junior high years where you’re a little unsure of yourself and got involved in some drug activity there,” Bright said.
Lisa said her son entered multiple rehabilitation centers from California to Alabama during his college years and would do well in recovery but would relapse when he was released. He then hurt his back while working at a local grocery store and was prescribed OxyContin for the pain.
“That’s where the opioids started to come in. Those were prescriptions given to someone who already had addiction issues, so it was a double-whammy for him,” she said.
“They monitor opioid use the best they can through prescriptions. But when you reach that max, you’re going to go looking for something else because of the addictiveness. That’s when you go to heroin, because an opioid is basically synthetic heroin.”
While Will Bright was not on Medicare, which is for adults 65 and older and younger adults with disabilities, Lisa Bright noted opioid misuse is a growing problem among older Americans who are likely to undergo surgeries such as hip and joint replacements and experience chronic pain. One study published earlier this year found nearly 80,000 Americans ages 55 and older died of an opioid overdose from 1999 to 2019. Yearly numbers of deaths increased over time, from 518 in 1999 to 10,292 in 2019.
Both Fox and Bright said they were optimistic the measure would pass through the House and Senate this year. Capito, who sponsored the bill in the Senate, told Changing America that lawmakers are continuing to build bipartisan support for the bill, as West Virginia has been “ground zero for the opioid crisis.”
“I’m hopeful this commonsense legislation gets across the finish line so we can prevent more families from losing sons and daughters to the scourge of addiction,” Capito said.
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