The menace in the medicine cabinet: The opioid epidemic’s pharmaceutical roots

In this series, Yahoo News takes a closer look at the current opioid epidemic, its roots and demographics, the increasing acceptance of medication-assisted treatment as a supplement to 12-step programs and the remaining obstacles to combating widespread addiction. This series also highlights ways in which the current crisis is unexpectedly forcing a larger shift toward treating addiction more like other chronic illnesses. 

One needn’t search further than the medicine cabinet to find the biggest culprit in today’s opioid epidemic.

Prescription opioid painkillers, like OxyContin or Vicodin, are intended to treat the kind of pain experienced after surgery or a serious injury, or by cancer patients. But according to the Centers for Disease Control and Prevention, “in recent years, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis.”

In 2012, doctors wrote 259 million painkiller prescriptions, “enough for every American adult to have a bottle of pills.” By 2013, the number of Americans who abused prescription painkillers had reached close to 2 million. And in 2014, the U.S. saw 28,648 opioid-related deaths.

“Each day, almost 7,000 people are treated in emergency departments for using these drugs in a manner other than as directed,” reads a CDC explainer on prescription drug abuse in the U.S.  “People who take prescription painkillers can become addicted with just one prescription. Once addicted, it can be hard to stop.”

In January, the CDC announced it was drafting new guidelines for the prescribing of opioids. The objective of these guidelines is to streamline recommendations and promote more training among primary care physicians for prescribing opioid pain relievers in order to “ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse or overdose from these powerful drugs.”

This month, the Food and Drug Administration pledged to change its approach to labeling, approving and prescribing opioids. (PDF)

“The FDA is deeply concerned about this growing epidemic, and I am personally disturbed by the toll it has taken in communities across the country,” acting commissioner Dr. Robert Califf told reporters. “It has reached a point where we felt we had to step back and take a careful look at everything and see what we could do. … We thought we could do more.”

Califf outlined the FDA’s new plan to “fundamentally re-examine the risk-benefit paradigm for opioids” and reduce “the impact of opioid abuse on American families.”

The plan’s core elements include a more transparent approval process for opioid drugs, improved communication with the medical community about the risks associated with these drugs and safe prescribing practices, and increased access to information about “the risks of misuse and abuse associated with long-term opioid use.”

The fact that the drugs responsible for widespread opioid addiction are far easier to obtain than the drugs proven to treat it is not lost on the small number of physicians who have completed the eight-hour addiction treatment course required to receive special DEA approval necessary to prescribe buprenorphine to a maximum of 100 patients.

“If we’re really going to expand access to treatment for heroin addiction, buprenorphine needs to be more accessible than [opioid painkillers] or heroin,” said Andrew Kolodny, chief medical officer at Phoenix House, a national nonprofit drug and alcohol treatment program.

Kolodny is pleased to see the Obama administration’s recent moves toward easing the federal restrictions on medications for opioid addiction, but is frustrated by how cautiously and slowly those moves are being made.

“Everyone’s worried we’re going to have buprenorphine pill mills, or that it will wind up on the black market,” Kolodny told Yahoo News. “But if they’re so worried about that, why aren’t they saying, ‘Let’s put restrictions on the other opioids?’ Why not have a training requirement? Why not have patient caps? If that drug is more dangerous and more addictive and it’s being prescribed inappropriately.”

Kolodny, who is also the executive director of the advocacy group Physicians for Responsible Opioid Prescribing, or PROP, knows the answer to his questions lies with big pharma.

“You don’t see policymakers talking about these kinds of restrictions because the opioid lobby is very powerful,” Kolodny said. “We’re in favor of the FDA better regulating the drug companies so they stop promoting so aggressively. … But even PROP is not out there pushing for these restrictions, because we know it’s not politically feasible.”

Read more from this series:

—This is your brain on opioids 
 
—How buprenorphine, or ‘bupe’, changed opioid addiction treatment
 
—Abstinence vs. medication-assisted treatment: Traditional 12-step programs embrace a new model 
 
—It's easier to get a prescription for drugs that cause opioid addiction than those proven to treat it
 
—The rise of Narcan, the life-saving opioid antidote that can stop an overdose in its tracks 
 
—Why the new face of opioid addiction calls for a new approach to treatment

—Facing an epidemic of overdoses, Obama rejects governors' proposal to limit painkiller prescriptions