NIDA’s Volkow Forecasts Future Pain Treatment Paradigm, National Opioid Response

In a series of remarks this week by Dr. Nora Volkow, the National Institute on Drug Abuse Director made it clear that there is still plenty of work to be done to help address the prescription opioid epidemic on the national level as novel abuse-deterrent or non-opioid products are still years away from being commercially available. The NIDA Director referenced rising overdose deaths rates from illicit substances, including but not limited to opioids, as a main beacon for the nation’s response. According to Volkow, it could be closer to a decade before these products are marketed, pending successful Phase II and III human clinical trials. Accounting for increased investment into this field by federal regulators and industry alike, significant strides are plausible over the next several years while still ensuring these new products do not pose any further risks to or potential for addiction and are subject to long-term review for efficacy.

On the issue of the opioid epidemic and overdose deaths due to addictive and illicit drugs, HHS Secretary Alex Azar had noted, “While the declining trend of overdose deaths is an encouraging sign, by no means have we declared victory against the epidemic or addiction in general…This crisis developed over two decades and it will not be solved overnight.”

Articles & Resources

POLITICO – NIDA Director: New Pain Meds are Still Years Away

POLITICO – NIH Leader Says U.S. Addiction Woes Are Far From Over

JAMA Researchers Highlight Discrepancies Among National Epidemic Response

Over the last week, a series of articles was published in the Journal of the American Medical Association and its related subsidiaries around the nation’s response to the opioid epidemic and efforts to abate rising overdose deaths. The three articles linked below provide a varied picture around the complex series of interventions required to address the nation’s opioid epidemic.

Led by researchers from the University of California Davis, it was found that states which expanded their Medicaid programs via the Affordable Care Act demonstrated lower rates of opioid-related overdose deaths – around 10% for substances such as heroin and synthetic opioids (e.g. fentanyl). Reviewing over 3,100 counties across 49 states, it was found that those who expanded the program fared better as compared to those who did not. Estimates are that expansion prevented between 1,600 and 8,100 overdose deaths over a three-year period.

However, research published in JAMA Pediatrics found that youth with opioid-use disorders and a prior overdose struggled to receive evidence-based pharmacologic interventions. Researchers found that, among 3,600 youth in the Medicaid program, less than one-third received treatment for their opioid-use disorder within 30 days of the incident and an even smaller percentage – 1.9% – receiving pharmacotherapy such as buprenorphine, naltrexone or methadone. Astonishingly, 69% of patients received no addiction treatment whatsoever and only 1 out of 54 youth received pharmacotherapy.

Articles & Resources

JAMA Pediatrics – Receipt of Addiction Treatment After Opioid Overdose Among Medicaid-Enrolled Adolescents and Young Adults

Journal of the American Medical Association – Views of Rural US Adults About Health and Economic Concerns | Substance Use and Addiction

Journal of the American Medical Association – Association of Medicaid Expansion with Opioid Overdose Mortality in the United States

CDC Finds Reduced Opioid Prescribing Upon ED Discharge

Research released by the Centers for Disease Control and Prevention’s National Center on Health Statistics this week found that between 2006 and 2017 the amount of opioids prescribed upon discharge from the emergency room decreased to 14.6% of all cases, down from 19.0% at the outset and nearly 22% at the high in 2010-11. Overall the most apparent decrease was found within patients aged 18-44 in which prescribing decreased from 25.5% in 2010-11 to just over 15% at the conclusion of the study. Geographically speaking, small metropolitan counties saw a concurrent, and statistically significant, decrease in prescribing over the same period from 24.3% to 14.5% in 2017. Overall prescribing of opioids at ED discharge was down 30% during the timeframe of interest.

Articles & Resources

CDC National Health Statistics Report – Trends in Opioids Prescribed at Discharge From Emergency Departments Among Adults: United States, 2006–2017

What We Read Last Week

STAT News – Faced with Fears of OxyContin Misuse, Sales Reps Touted Its Safety

POLITICO – FDA Defends Opioids for Chronic Pain Ahead of Advisory Committee

Vox – Study Links Medicaid Expansion to 6 Percent Reduction in Opioid Overdose Deaths

Bloomberg Government – Medicaid Expansion Linked to Declines in Fatal Opioid Overdoses

Star Tribune – Opioid-Dependent Kids’ Guardians Seek to Form Class in Suit

Law360 – ‘Opioid Babies’ Seek Class Certification in MDL

Law360 – Okla. AG, Endo Reach $8..75M Deal Over Opioids

Law360 – CVS, Walmart Look To Shift Blame To Doctors In Opioid MDL

Department of Justice – Former Los Angeles-Area Physician Sentenced to Two Years in Federal Prison for Defrauding Medicare and Illegally Prescribing Opioid Drugs

Department of Justice – Philadelphia-Area Doctor Sentenced to 12 Months in Prison for Unlawfully Distributing Oxycodone

U.S. Attorney for the Western District of New York – Local Pain Management Doctor Pleads Guilty To Conspiracy To Distribute Controlled Substances And Health Care Fraud

This Week’s Calendar

Back in the full swing of things, the House and Senate will host several relevant hearings and events during this upcoming week while additional focus will remain on national security and impeachment-related issues. Should there be any additions to House or Senate schedules or updates with respect to additional events, this information will be made available.


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