Pavilion Publishing and Media Ltd
Blue Sky Offices Shoreham, 25 Cecil Pashley Way, Shoreham-by-Sea, West Sussex, BN43 5FF, UNITED KINGDOM
Tel: +44 (0)1273 434 943
Email: [email protected]
Without evidence-based public health policies that treat drug addiction as a chronic condition and prioritise prevention, opioid overdose deaths are also expected to increase worldwide as the epidemic expands beyond North America.
A new report published in The Lancet, Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission, offer an analysis of the current state of the opioid addiction crisis and outline innovations in pain management and prescribing methods.
The authors say that the number of deaths from opioid overdoses in North America is predicted to grow exponentially, adding 1.2 million more overdose deaths by the end of this decade to the nearly 600,000 deaths that have already occurred since 1999.
What is the opioid crisis?
Opioids are an important class of painkillers historically prescribed mainly in surgery, palliative care, and cancer care, but now prescribed for many short-term and chronic conditions ranging from lower back pain to headaches to sprained ankles. Without proper supervision or alternative pain relief methods, millions of people have become addicted to prescription opioids and later to other illicit and synthetic opioids, such as heroin and fentanyl, leading to hundreds of thousands of fatal overdoses.
The opioid crisis began in the 1990s when policymakers and health care systems failed to stop the pharmaceutical industry’s aggressive push to increase opioid prescribing. The crisis became even worse over the past decade as illegal drugs such as heroin and fentanyl became widely available..
The year 2020 was the deadliest to date for opioid deaths in North America, totalling more than 76,000 deaths. The Covid-19 pandemic has simultaneously exacerbated and overshadowed the opioid epidemic by limiting access to opioid use disorder services, overwhelming healthcare systems, and creating stressors such as unemployment, disability, and loss of loved ones that can lead to greater drug use and addiction.
Commission Chair Prof Keith Humphreys of Stanford University said: “Over the past quarter-century, the opioid epidemic has taken nearly 600,000 lives and triggered a cascade of public health catastrophes such as disability, family breakdown, unemployment, and child neglect in North America. If no action is taken, by the end of this decade, we are predicting the number of deaths to be twice as high as it has been over the last 20 years, totalling upwards of 1.2 million overdose deaths by 2029.
“The opioid epidemic is a public health crisis that has developed over decades, and it could take at least that long to unravel it. To save lives and reduce suffering immediately, a cohesive, long-term public health strategy that can restrain and ultimately overcome the pharmaceutical industry’s powerful influence over health care systems is urgently needed. Health care systems also need to dramatically step up their effort to help people struggling with addiction.”
Evidence-based policies to tackle the opioid crisis
The Commission authors says urgent action is needed to improve regulation related to opioid over-prescribing practices and to make post-approval drug monitoring and risk mitigation a function of government.
“Our analysis clearly lays out how lack of effective regulation and an unchecked profit motive created the opioid epidemic. To ensure safeguards are in place to curb the opioid addiction epidemic and prevent future ones involving other addictive drugs, we must end the pharmaceutical and health care industry’s undue influence on the government and its unregulated push for opioid use. This includes insulating the medical community from pharmaceutical company influence and closing the constantly revolving door between regulators and industry,” says Commission author Prof Howard Koh of Harvard’s T.H. Chan School of Public Health (USA).
They also call for high-income nations where opioid manufacturers are based to extend restrictions and legal sanctions to global operations. To give resource-limited countries an alternative to partnering with for-profit multinational corporations, the Commission recommends that the World Health Organization and donor nations provide free, generic morphine for analgesia to hospitals and hospices in low-income countries.
Other recommendation include innovation and intelligent prescribing for pain management; treating addiction as a chronic condition with a focus on prevention and policy reform, and investing in young people to reduce risk of addiction.
Commission author Prof Yasmin Hurd of the Icahn School of Medicine at Mount Sinai, added: “Addiction is an enduring part of population health and should not be treated as a moral failing that needs punishment but as a chronic health condition that requires ongoing treatment and long-term support. We may not know what future addiction might take hold in our society, but we do know that without a public health foundation based in supportive recovery and prevention, addiction will continue to plague our health systems and our communities.”