In JAMA Article, Beletsky Calls for Federal Measures to Combat Preventable Overdose Deaths
11.13.12 — In tomorrow’s issue of the prestigious Journal of the American Medical Association, Northeastern University School of Law professor Leo Beletsky calls for urgent federal measures to combat preventable overdose deaths involving opioid drugs like Oxycontin. The article, “Prevention of Fatal Opioid Overdose” is coauthored by medical practitioner and researcher colleagues Josiah “Jody” Rich, MD, MPH, at Miriam Hospital and Professor of Medicine and Epidemiology at Brown Medical School, and Alexander Y. Walley, MD, Assistant Professor of Medicine at Boston University School of Medicine.
“Every year, at least 16,000 Americans die of unintentional overdose involving opioid drugs. This epidemic kills more people than homicides and AIDS, but it doesn’t receive nearly the same level of recognition or resources,” says Beletsky, an assistant professor of law and health sciences in Northeastern University's School of Law and Bouvé College of Health Sciences. He is also a core faculty member of Northeastern’s Program on Health Policy and Law.
In recent years, there has been increasing federal, state and local government attention to this issue, but solutions advanced to address it have been drawn primarily from the law enforcement playbook, such as prescription monitoring programs and “pill mill” raids, according to the article. The authors advocate for a more comprehensive, public health-based approach.
“Treatments for opioid addiction, which we know work, must expand in order to confront this growing epidemic. For those not ready for treatment, we need more tools to prevent overdoses,” says Rich, a researcher, primary care doctor and addiction medicine expert.
The good news is that in the 30 to 60 minutes it takes for an overdose to turn fatal, it can be effectively reversed by basic first aid and administration of the opioid antagonist, naloxone. Since help does not arrive in time for a staggering number of victims, community-based organizations and local and state governments have innovated by training and equipping members of the public and non-medical responders to recognize and reverse overdose events. Paralleling the recent advent of public access defibrillators, such measures have proven critical to stabilizing victims until they come under care of emergency medical professionals.
“Community-based overdose prevention programs that include overdose education and naloxone access can avert unnecessary, preventable death. The goal is to keep people alive long enough to allow treatment for opioid addiction to work,” says Walley, a researcher and a primary care and addiction medicine specialist.
Beletsky, Rich and Walley describe multiple barriers that constrain adequate responses: public awareness about the signs and symptoms of overdose remains low; naloxone is in severe shortage as its price has skyrocketed; few licensed prescribers are aware of, and are willing to participate in, overdose education or naloxone access initiatives; funding for program activities and evaluation research remains sparse; and naloxone’s FDA-approved formulation is ill-suited for utilization by members of the public.
The JAMA article is an urgent call to action for the Obama administration and federal agencies to overcome these barriers and move programs beyond the proof of concept phase. Among the key recommendations are: a more active role for the Food and Drug Administration in ensuring adequate and affordable supplies of naloxone; Substance Abuse and Mental Health Services Administration and Centers for Medicaid and Medicare Services action to facilitate healthcare provider participation in overdose education and prevention programs, including naloxone prescription; National Institutes of Health and Centers for Disease Control and Prevention funding for research and evaluation efforts; and coordinated agency action for boosting public awareness through multiple outreach channels.
For access to the full article, see jama.jamanetwork.com.
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