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Combatting opioid crisis requires public-private partnership

Francis Collins

The President’s Commission on Combating Drug Addiction and the Opioid Crisis recently met for its third public meeting to obtain recommendations from physicians and leaders in science and medicine on how to deal with the current opioid epidemic in the United States.

Nearly 27 million Americans suffer from chronic pain and 2 million abuse opioids — most of whom started with prescription medicines, Francis Collins, MD, PhD, director of NIH, noted at the meeting.

It is almost impossible to be able to recover from opioid addiction without medication assistance due to a rewiring of the brain, he added.

“While there are effective treatments for opioid use disorder, they are underutilized and the number of options is limited,” Collins said. “Furthermore, we as doctors don’t even really know how to make these medications work for all patients. For example, relapse rates after treatment are way too high and the duration that is needed for sustained abstinence is not really known.”

Our understanding of the pathways involved in addiction in pain has been revolutionized by recent neuroscience research and now some new and urgently needed nonaddictive pain medications can be pursued, he said.

The goal now is to build a public-private partnership between researchers in academia and the industry with help from the government, particularly the NIH and FDA, who have halved the time necessary to make new potent and nonaddictive medications for pain and addiction available, he said.

There are two themes to developing a plan to combat the opioid crisis, according to Collins.

“The first focuses on medications to treat addiction and reverse overdose,” he said. “Changes to combinations and formulations of drugs currently in use can be very helpful in providing additional options for treatment. ... The second theme focuses on the development of potent but nonaddictive medications for pain. We need to offer [individuals suffering from pain] opportunities for treatment that do not carry with them this terrible consequence. Frankly, treatment of chronic pain with opioids is not very successful anyway. We desperately need other alternatives in that space.”

Focused data-sharing efforts should be the first place to start this process, Collins said.

“The industry has been developing alternative pain medicines, but many of those are still in the process of being evaluated in the clinical stages, and the industry now seems to be willing to do more sharing about that information, so we can focus the efforts on the ones that are going to most likely succeed,” he said.

In addition, Collins noted that biomarkers are needed to be able to distinguish distinct kinds of pain in different populations because clinicians lump pain syndromes together too often, but the treatment for one kind of pain may be very different from another. Objective measurements of pain, rather than a pain scale of 1 to 10, are also needed, he said.

“We are now very close to seeing what this network could look like,” Collins said. “We can [end this epidemic, but] it’s not going to happen overnight. If we put every bit of energy [into developing public-private partnerships], we can accelerate some of these advancements, particularly improving assisted treatment options.”

During the meeting, Stephen J. Ubl, CEO of PhRMA, stated that clinicians should limit opioid prescription to a 7-day supply for acute pain management.

“Too often patients are given a 30-day supply of opioids for minor or short-term pain,” Ubl said. “Overprescribing can lead to patients taking excess pills and risk these pills falling into the wrong hands.”

Advancements in the opioid crisis can be undermined if we do not address insurance coverage barriers, he noted.

Several representatives of various pharmaceutical companies took the floor to testify at the meeting, agreeing that a main contributor of the opioid epidemic is the lack of alternative opioids and thus, the development of novel drugs that are highly effective but nonaddictive are needed.

James Campbell, MD, chief scientific officer for Centrexion Therapeutics and past president of the American Pain Society, emphasized the importance of realizing that one of the major factors leading to the opioid crisis is chronic pain itself.

“Current treatments are inadequate,” he said. “Our nation needs a moonshot commitment to the development of nonopioid pain treatments. We need new therapies and we need them fast. The abuse of opioids cost lives, but an equally important issue is the problem of untreated pain. Untreated pain results in loss of work, depression, lack of sleep, social withdrawal and may even lead to suicide.”

There are opportunities to foster development of new treatments, which start with addressing the barriers posed by the business, regulatory and reimbursement environment, Campbell said.

A major breakthrough may be possible by targeting a new class of pain receptors to reduce the probability for addiction because of the lack of mood alterations, Christian Kopfli, of Chromocell, said.

“Evidence shows that the adoption of alternative pain management strategies that utilize nonopioid medications can effectively manage patients’ post-surgical pain while reducing or eliminating opioid consumption,” David Stack, of Pacira Pharmaceuticals, said. “The technology is available today, yet the current reimbursement policies implemented by CMS are making it difficult for hospitals and ambulatory or surgery centers to adopt these strategies. ... By changing these policies, government decisionmakers can make an immediate contribution to combatting the epidemic.” – by Alaina Tedesco

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.