By Maggie Gorini
The opioid crisis is big news these days, and with good reason. In 2017 alone, there were 70,237 drug overdose deaths, two-thirds of which involved opioids.i Accidental drug overdose is the leading cause of death in the U.S. among people under age 50.ii We need policymakers, insurers, voters, and practitioners to come together in a multi-pronged approach to prevent these tragedies. Yet for years, interventions designed to prevent addiction and opioid-related overdoses have been ineffective or downright harmful. Thankfully, that’s starting to change.
For example, criminalizing opioid use for mothers and pregnant people backfires in ways that ultimately hurts children and mothers. When a pregnant person who is struggling with a substance addiction is arrested, held, and/or incarcerated, the disruption can lead to major ramifications for her and her family.iii Pregnant people risk losing their jobs, homes, and/or children when they are prosecuted for these charges, creating an enormous disincentive for them to seek medical care—including addiction treatment. And, these laws are disproportionately enforced against women of color and low-income women.iv The threat of criminal prosecution for abuse, neglect, or reckless endangerment of a fetus is not, it turns out, a viable way to help prevent people from using opioids.
The NWHN believes states should change their policies and decriminalize drug use for pregnant women. Treating substance abuse as the health concern it is rather than a criminal problem enables women to manage and overcome addiction.v We support programs like the new Maternal Opioid Misuse (MOM) model to improve access to care for pregnant and postpartum Medicaid beneficiaries with opioid use disorder.vi
Another vital change stems from Medicaid expansion under the Affordable Care Act (ACA). States that have expanded Medicaid have significantly improved access to health care and helped low- and moderate-income people get substance abuse treatment. Expansion states need to keep making progress by covering a key opioid addiction treatment program called Medication-Assisted Treatments (MAT).vii MAT provides drugs—including methadone and buprenorphine implantsviii ix—that help reduce withdrawal symptoms and cravings so people can overcome their bodies’ needs and further their recovery.x xi xii MAT is most effective when people can get the services from a clinic daily, so even short lapses in insurance coverage can undo months of addiction maintenance. States need to keep working on ensuring that women have reliable, consistent health care and the services that help them get services, like childcare.xiii
Through our partners at Raising Women’s Voices for the Health Care We Need (RVW), the NWHN is working to expand Medicaid in the 14 states that have yet to do so. This will be a huge shift in ensuring that low- and moderate-income families have access to care—including addiction treatment.xiv xv Expanding Medicaid in all states and covering a larger number of people is vital to protecting women’s health, including access to addiction treatment programs.xvi
On the regulatory front, the U.S. Food and Drug Administration (FDA) is shifting to a more active approach to addiction prevention efforts, but the agency can do more. The FDA has approved new “abuse-deterrent” (AD) opioid reformulations in an effort to prevent drug abuse but needs to address the fact that patients and/or their caregivers may mistake “abuse-deterrent” to mean “less addictive,” which isn’t true. Patients may accept treatment regimens they believe to be less risky when, in fact, AD medications are often just as addictive as non-AD formulations. We want the FDA to be more vocal about AD formulations’ limitations, so people can make informed decisions about their care plans.
We also want the FDA to maintain its commitment to consumer safety. The FDA’s Innovation Challenge (IC) incentivized manufacturers to create diagnostic or therapeutic products to prevent pain and/or address addiction and abuse, and several new products have been rushed to market.xvii Rapid responses have their benefits, but the FDA must not lose sight of consumer safety. The FDA should implement discrete, enforceable timelines for these products’ post-market studies, including patient-reported information about effectiveness. This is essential for providers and patients to have accurate safety and efficacy information about the drugs they take.
We also want to see the FDA change its approach to preventing illegal online sales of these drugs. The agency has sent warning letters but has yet to impose criminal penalties against companies that sell opioids illegally online.xviii It’s long-past time for the FDA to seek criminal and/or financial penalties to discourage these activities.
Insurance companies also need to adjust their approach to the epidemic. For too long, many insurers didn’t cover non-drug and non-opioid alternatives to opioid medications for pain, like physical therapy or counseling.xix xx xxi The NWHN urges insurers to change their policies and support alternative treatments and limit the number of days an opioid prescription is covered for new patients.
Doctors are starting to change how they treat pain management, as well. They are coming together to reevaluate which conditions and procedures actually warrant an opioid prescription and which do not. For example, oral health professionals at Johns Hopkins University are working on strategic alternatives to opioids for some types of pain mitigation.xxii
Finally, communities are changing how people who have overdosed get helped by expanding access to naloxone. Naloxone is a drug that can help reverse an overdose by helping unconscious overdose victims to breathe again.xxiii xxiv Traditionally, naloxone was administered by first responders, but those front-line professionals can’t always reach overdose victims in time. And, they may be more likely to give the drug to men who have overdosed than to women.xxv Now communities are working to make sure naloxone is available when it’s needed and not just from first responders. For example, states are allowing pharmacists to prescribe naloxonexxvi and communities are placing naloxone kits in the AED cabinets found in public spaces like airports.xxvii
These are just a few of the changes stakeholders are making to advance effective programs and policies to address the opioid epidemic. We are starting to recognize what works: focusing on evidence-based interventions rather than punitive ones, increasing access to the full range of health care services by expanding insurance coverage, and prioritizing people’s health over drugmakers’ profits. We need stronger political, financial, and regulatory will to support programs and policies that actually work, however. Only when all these elements are in place will we turn the tide of this epidemic and effectively address its devastating impact on women and their families.