Jennifer A. Collins, PhD, F-ABFT
VP Operations/Discipline Director Forensic Toxicology—LabCorp
As most everyone knows, the U.S. is in the midst of an opioid epidemic. In 2017 the Department of Health and Human Services (HHS) declared the opioid epidemic a public health emergency, but the roots of the problem go back much further. The issues began in the late 1990s with changes in the way that chronic pain was treated. Between 1999 and 2012 there was a substantial increase in prescription rates for opioids before it became clear that these medications could be highly addictive and dangerous. Along with this increase in prescription rates came dramatic increases in opiate overdoses. Between 1999 and 2018 almost 450,000 people died from overdoses that involved either prescription or illicit opioids. The Centers for Disease Control and Prevention (CDC) has characterized the epidemic into three distinct phases.
• The first phase began in the late 1990s and was dominated by prescription opioids that were natural or semi-synthetic such as methadone, hydrocodone, and oxycodone.
• The second phase began around 2010 and was marked by an increase in overdoses involving heroin.
• The third phase began in 2013 where the country saw the impacts from synthetic opioids, especially illicitly manufactured fentanyl.
Even though the prescription rates are dropping, our communities across the nation are still flooded with opioid prescriptions. The CDC reported that over 168 million opioids were still prescribed in 2018. To complicate matters, we are currently at the crossroads of two separate health crises. The COVID-19 pandemic raises new risks and creates additional challenges for patients with substance use disorder (SUD), and data indicates that drug overdoses are spiking during this new pandemic. In response, Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Drug Enforcement Administration (DEA) have increased flexibility for providing buprenorphine and methadone to patients with opioid use disorder. The CDC has developed a resource page for patients and healthcare providers who are navigating treatment of SUD during the current COVID-19 environment.
Even before the current COVID-19 pandemic, multiple organizations recognized the need to balance the risk and benefits of opioid therapy especially in patients suffering from chronic, painful conditions. In response, Opioid Prescribing Guidelines issued by the CDC and the American Academy of Pain Medicine recommend that healthcare providers perform a benefit-to harm assessment for the individual patient. Several screening tools have been developed to assess patient risk with chronic opioid therapy (COT). For consumers, public service awareness campaigns strive to educate Americans about the risks of opioids and encourage patients to talk to their doctors about opioid alternatives.
What Can Be
Since declaring the opioid epidemic a public health emergency, HHS launched a 5-point strategy to combat the health crisis. At the top of the list is the need to expand access to treatment and recovery services such as Medication Assisted Treatment (MAT). In 2016, at least 2.1 million people were living with an opioid dependency, while only 374,000 individuals sought treatment. There is a significant need to empower more physicians with the ability to provide MAT in order to improve outcomes for opioid-dependent patients. Research has shown that SUD is a chronic condition. Now, more than ever before, programs and policies are being implemented so that SUD can be treated like other chronic conditions.
Medical schools in the United States are beginning to integrate courses covering pain-related incidents and SUD. Major insurance plans are taking leadership roles in promoting and covering holistic and collaborative care of patients with SUD. Technology companies are developing software to connect each part of the care team ecosystem.
Like most large problems, there is no single solution to conquering the opioid crisis. Collaboration among physicians, counselors, laboratories, pharmacies, policy makers, insurance companies, and many others will be required to overcome this crisis. Cultural changes in the way society treats people with substance use disorders will also be necessary. This is perhaps the best news of all—that we can each play a part in reducing the impact of the opioid crisis in our country.
In an effort to address the opioid crisis, LabCorp has developed several test options to help manage Suboxone® MAT for SUD. Click here to learn more. LabCorp also offers a comprehensive test menu to help meet the drug testing and clinical testing needs of different patient populations.