In the hyper-partisan world that is Washington DC these days, it’s a wonder that anything gets done at all. Bipartisanship seems like a lost skill set as few of our federal legislators want to work with members of the opposite party. However, there are a few select topics which still can command special attention. The opioid crisis is one. In a surprising vote of 98-1 in the Senate and 393-8 in the House both chambers passed a new opioid bill which the President is expected to sign.
However, as with any large plan, there are critics of the bill. It only allocates $8 billion in federal spending over the next 5 years. Experts say, to have a significant impact, tens of billions of dollars need to be dedicated to the problem. And, it’s still a very large numbers problem. In less than 30 years an astonishing 700,000 people have died from drug overdoses, mostly opioid-related. That’s equivalent to a very large U.S. city that has been wiped out! After spiking recently, the carnage has leveled off over the last couple of years yet, 72,000 people died last year.
The bill has many components, but a few which are more relevant to family physicians and our patients are:
Importantly, the bill does not authorize a substantial increase in funding for addiction programs. Everyone agrees that more, much more is needed for treatment programs.
Another provision of the new opioid bill is to increase penalties to medication distributors and manufacturers relating to overprescribing of the drugs. This seems like it falls into the too little too late basket. As one example, it was well publicized that early on Purdue Pharma was targeted by federal prosecutors as a major abuser of heavily promoting their narcotics to providers. As seems all too typical in these kinds of cases (see the financial crisis of 2008), the fines paid were easily covered by corporate profits and no corporate executives went to jail. With the convoluted news cycles these days, I’d wondered if anyone even noticed Purdue’s culpability. Then, out of the blue recently, while watching the Late Show with Stephen Colbert, he dedicated an entire time slot to publicizing and skewering Purdue’s involvement including through its subsidiary Rhodes Pharma. It was really a surprising segment. As an FYI, in the “it can’t get any more ironic” category, Purdue has now patented a buprenorphine wafer product to use in overdose reversal (so profiting on the backside of the issue too).
Fortunately, front-line physicians don’t seem to have taken the public brunt of the blame of addiction. But last week’s 60 Minutes show opened their program asking the question as a binary choice of who was at fault, prescribers or manufacturers. Most of us likely had a few patients on reasonable doses that we watch closely. However, we all knew a couple providers who were prescribing outside typical boundaries - typically only the most egregious ones. I actually thought 60 Minutes did a fair job of exposing a few high prescribing/promoting physicians, and the critical roles of Purdue and Mallinckrodt Pharmaceuticals. It’s a worthwhile program to watch.
A reminder that WAFP has periodically rolled out an opioid CME which meets the Wisconsin licensing board requirements. The next course starts in November and is discounted to WAFP members.
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