Congress: To prevent addiction, empower physicians and patients to choose non-opioids

Every month, it seems, the United States smashes another unenviable record when it comes to drug addiction and overdose statistics. According to the Centers for Disease Control and Prevention (CDC), the latest data show a jaw-dropping 108,000 overdose deaths in 2021. America’s families and communities are reeling — and the federal government needs to help.

As part of a broader strategy to save lives, Congress and the Biden administration must embrace efforts to prevent addiction before it can begin. This means reducing the overprescribing of opioid-based medications, preventing the illicit use and diversion of these powerful drugs, and expanding access to a wide array of drugs and devices that can often manage pain without the risks of addiction.

Opioids are potent painkillers. As part of a carefully managed treatment plan, they can be miracle drugs for many patients who experience severe pain. But given the inherent risks, as well as each individual’s unique situation, opioids should not be the first-line treatment for everyone.

It’s widely accepted that the crisis we find ourselves in today was fueled by the overprescribing of opioids — a trend that continues despite some progress. In 2020, doctors wrote over 142 million prescriptions for opioids, or 43.3 prescriptions per 100 persons. The CDC found that some counties still have opioid prescribing rates that are a whopping nine times the national average, and roughly 4 percent of counties dispense enough opioid prescriptions for every resident to have one.

Surgery is a common pathway for prescription opioid use, with the average surgical patient receiving 80 pills after the procedure, approximately half of which are left in medicine cabinets and are amenable to potential diversion and abuse. Considering these factors, it’s not surprising that 9.3 million people misused prescription pain relievers in 2020 — ten times more than the number of people who used heroin. Unfortunately, older Americans are not immune to addiction: Roughly three percent of Medicare beneficiaries live with opioid use disorder (OUD).

Prescription opioids are many people’s first experience with opioids (few start by taking heroin or fentanyl) — but overly restrictive policies forced many people who became addicted to prescription opioids to seek illicit drugs when the prescriptions became harder to obtain. Much of this downward spiral could be avoided if opioids were prescribed more appropriately in the first place.

The Food and Drug Administration (FDA), in collaboration with researchers from Harvard University and Massachusetts General Hospital, recently published research that offers some insight into how focusing on prescription opioids might help address the current crisis. The findings suggest that decreasing the number of people who receive an opioid prescription reduces the prevalence of opioid use disorder and overdose deaths. Although the effects are minor at first, they compound over time to create a major benefit for society. The study also found that interventions designed to prevent the misuse and diversion of prescription opioids is “among the more effective interventions available” to prevent opioid addiction and overdose.

The FDA has approved many non-opioid alternatives for pain management, including long-acting local anesthetics, non-steroidal anti-inflammatory drugs (NSAIDs), and sympathetic nerve blocks, among others. Having served at FDA for many years, and also having both administered and used some of those products and procedures, I have no doubt that they are safe and effective, and that the benefits of using them far outweigh the risks.

Despite all this, non-opioid interventions are not utilized nearly enough. Instead, many physicians still rely on opioid-based painkillers as the default treatment option simply because Medicare payment policy creates perverse incentives for doing so. Medicare should not favor one type of pain management approach over another; instead, there should be a level playing field for all FDA-approved drugs and devices so that doctors and their patients can make the decisions about how best to treat post-surgical pain.

Fortunately, Congress is working to remove the barriers that disincentivize doctors from considering non-opioid alternatives. The bipartisan Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (H.R. 3259/S. 586) has garnered an impressive 47 co-sponsors in the Senate and over 100 co-sponsors in the House. If enacted, the legislation will ensure that both opioid-based and non-opioid-based treatments are reimbursed by Medicare at the same rates in the ambulatory surgical centers and hospital outpatient department settings.

Given the magnitude of the crisis, the NOPAIN Act would not be a silver bullet, but it would help to reduce the incidence of opioid use disorder and overdose deaths in the years to come. For the sake of patient health and choice, it’s long past time to treat FDA-approved non-opioid approaches fairly. The NOPAIN Act is a no-brainer.

Henry I. Miller, a physician and molecular biologist, is a senior fellow at the Pacific Research Institute, a free-market think tank. He was the founding director of the FDA’s Office of Biotechnology and a Research Associate at the NIH.