The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT Act, is now the law of the land. This comprehensive, bipartisan bill, which aims to address the prolonged national opioid crisis, offers a rare opportunity to applaud progress in the national effort to address one of the great health care epidemics of our time: misuse of opioids and other prescription drugs. But there is still much more work to be done.
Entire families and communities have been devastated by opioids. In a recent national poll, nearly 1 out of 3 Americans knows someone who is or has been addicted to some form of opioid. The Centers for Disease Control and Prevention estimates that, since 1999, more than 600,000 people have died in the U.S. alone from opioid-related overdoses.
While the new law is a positive step in the right direction, it fails to address several root causes of the epidemic. As a physician who cares for patients with chronic pain every day, as well as those with substance use disorders, I urge policymakers and the new Congress to maintain their focus on the opioid crisis by instituting policies and investing in the following three key areas.
First, the SUPPORT Act may not do enough to ensure that patients in chronic pain who legitimately need access to long-term opioid therapy can get these medications when they need them. According to the CDC, slightly more than 20 percent of Americans suffer from chronic pain. There’s no question that restrictions on prescribing opioids, use of non-opioid treatments, and development of non-addictive therapies are essential to preventing overdoses and deaths from the misuse of opioids. Yet as I know from my work as a pain specialist, many people with chronic pain require long-term opioid therapy to experience meaningful pain relief. For these Americans, this therapy is essential to simply function in society; they are not “addicted.”
The new law is curiously silent about long-term opioid use. Fortunately, the CDC does provide guidelines for the administration of opioid therapy for chronic pain. These include recommendations for drug monitoring at the beginning of treatment and at least once a year to help minimize the risk of drug misuse and substance use disorders.
Second, the act makes strides to improve the effectiveness of state Prescription Drug Monitoring Programs, but falls short in defining the type of data they should include and maintain. State-level prescription drug monitoring programs track which patients have been prescribed opioids, along with when and how much. Health care providers can access this information before prescribing additional medications. Today, 49 out of 50 states have such monitoring programs. The SUPPORT Act strengthens them by supporting data sharing across state lines with enhanced federal matching funds for implementing sharing among states with these agreements.
While prescription drug monitoring programs play an important role in preventing so-called doctor shopping, they tend to provide limited information about actual drug use. As currently constructed, these programs track information on drugs the patient has been legally prescribed. They do not show if a drug has been taken as prescribed, or if it is being combined with other, possibly illicit, substances. Relying on prescription drug monitoring programs alone for data means that drug use is mostly inferred, not verified.
This limitation becomes especially problematic given that a 2018 report on drug misuse conducted by Quest Diagnostics, a company I advise, found that 52 percent of nearly 4 million Americans who were monitored in 2017 for drug use had misused their prescription drugs. Rates of misuse were high across age ranges and gender, and occurred among those in both public and private health plans. The same report found that the type of data that states use in prescription drug monitoring programs may severely underestimate the rate of potentially lethal drug combinations.
For example, data on prescriptions suggest that less than 10 percent of patients combine opioids and benzodiazepines. Taken together, these two drugs can depress respiration, causing death. In contrast, a peer-reviewed study in the Journal of Addiction Medicine based on Quest laboratory data indicate that the combination rate is closer to 21 percent.
Third, the SUPPORT Act focuses on prevention, treatment, recovery, and enforcement. But unlike the federal government’s response to the HIV epidemic in the 1980s and 1990s, it does not promise long-term funding. Trends in the opioid crisis over time show that without sustainable investment in treatment and recovery services, those who misuse drugs will continue to do so.
The bipartisan effort for the SUPPORT Act was a major step toward reducing the drug epidemic, but we still have a long journey ahead. As states put this law into action, they will need to consider additional policies and make sustainable investments to address the opioid crisis and have a meaningful impact on it over the long term.
Jeffrey Gudin, M.D., is director of pain and palliative care at Englewood Hospital and Medical Center in New Jersey and a medical adviser for Quest Diagnostics. He is a consultant to various pharmaceutical companies on the development of new analgesics, including abuse-deterrent opioids and opioid alternatives.