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.

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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.

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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.

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  • I totally agree that chronic pain patients are being punished because of the opioid abusers. I’ve had 7 back surgeries with multiple fusions. One was a triple thoracic fusion. I’m lying in bed, one day post op and a PA comes into the room and begins to lecture me on opioid addiction! I couldn’t even turn over without assistance. I had no history of addiction and would only take maybe 2 Percocet per week when the pain from my other surgeries became unbearable. If I had had the strength, I would have blasted her. How dare you deny me pain relief after having 6 bolts with connecting rods inserted into my back!! And having 2 lumbar fusions. I struggle every day to walk. I’m doing everything I can to remain mobile. I worked 40 yrs as an RN, so I know all to well about trying to hold a job and have a life. I’ve had 3 pinches in my spinal cord that have required surgery. After my last lower back surgery, all I got was IV Tylenol and an occasional Percocet for before therapy.
    Pain management is no longer pain management. I can’t take NSAIDs due to only having 50% of my kidney function. Some days I can hardly function. I also have connective tissue disease, so that causes me daily pain. On my bad days, I try and wait until 5 pm to take one Percocet and pray that it relieves some of my pain. At best, I get maybe 2 hrs of mild relief. I have considered trying medical marijuana but I can’t afford it. This is not the way I envisioned spending my retirement. I was forced onto disability because I could no longer perform my job as a nurse. It was a sad day. I cried as I had to pack away my uniforms. I still feel like a failure. The only thing that keeps me hanging on is my daughter and my cats.
    These legislatures that make these laws need to spend time with chronic pain patients and walk a day in their shoes. Maybe then they would understand how chronic pain negatively impacts their lives
    Please continue to fight for those of us with legitimate chronic pain.

  • It is doubtful any of this will do much more than intrude on patents, and their doctors, while people with addiction continue to go without treatment. There has been no effort to apply any kind of rational science based approach. This problem has been festering for years, and there is still plenty of misinformation, lies and deliberate misreporting.
    In order to understand one has to throw away facts and science, and start reading their local papers, and listen to TV and radio shows on the topic. Many articles about the so called opiate epidemic run in the business section of newspapers, since the scourge is still being represented as an opportunity to profit.
    One of the biggest red flags has been the abject failure to track anything that has already been done. One state had a PM System in place in 2011. Prescription monitoring did nothing to slow Heroin deaths, or death, hospitalizations or overdoses by other illegal drugs. In fact many of the numbers they used to spread hysteria, and misinformation were misleading. The misreporting, has probably led to even more deaths. While they were blaming and targeting pain patients, addicts were dying from Fentanyl.

    Many of the articles, sensational news stories and advertorials, left out the facts, or made false claims about opiates, claiming they did not work for chronic pain. This is a lie that they used to sell books, treatments, devices, quackery, and expensive treatment. The so called Opiate Epidemic became a fear based marketing tool. Entire careers were made debasing pain patients, and blaming them for the drugs that were diverted illegally from the supply chain. There was no meaningful response as the facts came out on the number of doses that were being diverted or the pill mills became common knowledge. Regulatory agencies failed, while micro managing patients, and leaving pain untreated.
    Even now there is no real response based on facts. Patients and Physicians were micromanaged years ago, yet the media is still referring to pill mills. Millions of opiates were diverted from the supply chain, yet they still chose to target vulnerable patients. Now as Heroin and Fentanyl are the leading causes of overdose or death, pain patients are still being persecuted.

    The media continues to run the false narrative about prescription drugs. They are still demonizing addicts, pain patients, and even dependent babies. They run misinformation in the opinion sections, or as advertising. This country used to have laws about health related advertising, now even opiate deaths are an opportunity to peddle something.

    Plenty of physicians and self proclaimed experts used the opiate epidemic to enrich themselves, as people died. Pain patients are committing suicide, yet those numbers are misreported. The media to protect pharma and the other industries that are still profiteering, conflated addiction, and dependence, in order to demonize pain patients. Weaponized targeted marketing, used fear to sell pain implants, addiction cures, and useless alternative medicine Pharma peddled useless alternatives too, making even more profit form the disaster they had a hand in creating.

    Hospitals used the current hysteria, to deny care to people who reported pain. The fear of opiates and addiction made anyone reporting pain, a suspect. They got more attention for their positive PR releases, and advertising, if they demonized pain patients and misled the public.

    This country is still in denial, no effort whatsoever has been made to remedy any of this. There has been no attempt to get the facts, since there is money to be made in misinformation. Look at TV pundits, like Dr. Drew, spreading misinformation so he can profit. There are people whose careers depend on misleading the public. There used to be something wrong or immoral about peddling snake oil, while people die. Now in the US any kind of profiteering from the Market Based Healthcare System is considered innovative.

    There are few people out there on the Internet telling the truth, but that does not get amplified, it is not sensational enough, or even worse it shows the dark side of failed regulations, and our broken healthcare system. There is still no fact based acknowledgement of what they did wrong, or a demand for media to provide facts.

  • How much further into my private medical care is the government planning to go? The dangers of prescription pain pills have been exaggerated by zealots to the point that many chronic pain patients are being literally tortured by having the meds they use to manage pain ( not to get high ) taken from them for no good reason.
    Prescriptions for pain pills have been going down for years, even before the draconian CDC guidelines wreaked havoc onto the chronic pain community.

    Causing pointless suffering and deaths, often by suicide, to chronic pain
    patients has not helped solve the street drug crisis. Record numbers of addicts die every day from IV street drugs. When will people figure out that harming one group of patients can’t save another group, even if it worked it still wouldn’t be right to allow people to suffer.

    Addiction is a disease. Chronic pain is also a disease. They are not the same disease.

  • Same thing happened to me. First my family doctor said it was too risky for him to prescribe pain medicine then anxiety medicine. He cold turkey stopped the pain medicine & said he’d wean me off the benzo. (1mg a day is all I ever took!) He did not wean me off, he handed me my last prescription in May & I never seen him again.) . I went to pain management & was told they will not give pain medications. They tried to give me something like suboxone. I never even took enough pain pills in my life to require something that strong. My insurance denied it stating I needed to be on weaker drugs first & they listed Fentanyl, oxytocin & morphine. Bottom line, I live in my bed now wondering when I’ll snap from the pain. Thalimus pain syndrome from a brain hemmorage stroke. 9 years of torture & counting.

  • Dr. Gudin,

    I am a 100% totally and permanently disabled veteran who was injured in the service of our county. I take narcotic pain medications on a daily basis for intractable pain. Nothing else works and the narcotic pain meds give me back some quality of life and I can do things again. With out the narcotic pain meds I would be bedridden. I have tried 100s of treatments for the past 25 plus years and nothing else has worked.

    I get the medications from a pain doctor. I have to pay out of pocket for the doctor and the medications because the VA no longer treats veterans with pain medications. I am drug tested regularly and I never abuse my medications.

    YET, I am made to feel like a criminal because I was unfortunately injured in the military and now suffer chronic pain. Is this what our founding fathers intented for our country to do to people in pain? I understand there are people who abuse narcotics. I am not one of them, so why should I suffer in extreme pain because others abuse the medications that make life bareable to me. The only crime I committed was being injured and having chronic pain. I have never abused any medication. So why am I the one who is punished??

    And it is not just me, there are thousands of people just like me who are being made to suffer in extreme pain because other people abused drugs that make life liveable again for us.

    Please help us and make it possible for chronic and intractable pain patients to be able to get our medications and our doctors to prescribe the medications that help us. Punish the drug abusers not chronic pain patients!!!

  • According to my “Pain Management” the feds have dictated “no more opioids” period. I used opioid therapy successfully for years. Two years ago they started cutting dosages and by the beginning of this year I had to apply for permanent disability. After large cuts in my remaining meds I am largely bed ridden. I know they will shortly discharge me with nothing. I really want to hang on long enough to meet my grand kids, but at this level of pain, I honestly don’t know if I am strong enough. “Pain management” has been replaced with “Go home, shut up and deal with it.” How long befor we start counting the people who either quit eating and drinking to get the ultimate pain relief, and we, that the feds have abandoned to die, become the next epidemic. Note: I am typing this from my son’s laptop while in bed. It is really the only thing I can still do.

  • Non-prescription drugs such as acupuncture can be used simultaneously with opioid drugs to reduce the over prescribing of opioids.

    Bring acupuncture into the overall health system.

    • Tust, I agree acupuncture needs to be covered as it is very beneficial to many. However, it isn’t right for everyone. The CDC “Guidelines” need to be abolished and doctors need to be the sole prescribers for their patients. Overrides, prior auths and denials have to be stopped or the next epidemic, of suicide due to unbearable pain, will take first place as the new opioid crisis.

    • Acupuncture is a Fraud. There is no evidence that acupuncture relieves pain or treats anything else. In fact there seems to be a connection between peddling this kind of quackery and suicides opiate deaths. Most chronic pain Patients have tried alternative medicine out of desperation, and not only found zero relief, they are bilked out on thousands of dollars.

      The government need to crack down on this kind of quackery, and we need to start tracking the number of people injured or killed because of chiropractors, acupuncturists and other frauds.

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