These HHS guidelines on naloxone are a great step in the right direction. We do need to make life-saving naloxone as readily available as possible to anyone who is at risk for an opioid overdose. Barriers preventing this availability need to be removed and I stand behind HHS 100% on their decision to encourage this.

However, with these guidelines, the HHS continues to overemphasize opioids role in pain management while neglecting the greater necessity of understanding addiction as a disease which transcends a particular substance and has etiologies that are much broader than physical pain. For instance, more adults die every year from alcohol and tobacco and more adolescents are seen in the emergency room due to cannabis than from opioids. The substances people are using are evolving rapidly, such that methamphetamine and fentanyl have been implicated in the sharpest rise of deaths over the past couple years. Better pain management and responsible opioid prescribing will not significantly impact the vast numbers of people currently suffering from addiction or those likely to develop an addiction unrelated to a pain pill prescription. Physicians need to be given the resources and training to better screen for all addictions and provide the necessary psychosocial interventions to adequately address the disease.

For opioid use disorder, we desperately need to expand medication-assisted treatment into every community. Ideally, patients should have access to this evidence-based treatment on demand. Clinicians may want to consider the medication-assisted treatment model our health system employs. Ours is a shared medical appointment model that directly links the prescribing of a medication with psychological therapies and community resources. We strive to address the biologic, psychologic and social components of the disease and do so in a way that is financially sustainable. We have been practicing this model for the past fifteen years and have seen much long-term improvement in the lives of our patients.

It would behoove HHS to consider these types of models and other innovative approaches as well as steer more funding towards the prevention and behavioral health initiatives that are lacking in many U.S. communities. Doing so will make a more significant dent in not only the current opioid crisis, but also the much greater addiction epidemic rampant in our nation.

HHS is taking a step in the right direction with these guidelines regarding naloxone. These guidelines are particularly helpful for those patients who higher strength narcotics, or have respiratory issues like COPD or sleep apnea, since they have a tendency to develop dangerous acid-base disturbances that can be exacerbated by high doses of narcotics.

Though Narcan is helpful, it is not the long-term solution to the opioid crisis. To more completely address this epidemic, we need to be focused on rehabilitative therapy, such as individual or group counseling, combined with medication-assisted therapy like Subutex or Suboxone that bind to opioid receptors in the brain and control withdrawal symptoms, but do not have the euphoric properties that other opioids do.

Narcan is a great emergency option to opioid overdose. This medication gives patients another chance and in some of these patients, one overdose is enough to convince them that he or she needs to overcome their addiction to opioids. But in a lot of cases it doesn’t, and one in ten people saved by Narcan will die from another opioid overdose within one year.

Think of it this way: a defibrillator will save many patients from dying from a cardiac arrest, but it does not stop the problems that led to the heart disease in the first place, such as smoking, unhealthy diet, sedentary lifestyle, etc.

Getting patients into rehabilitation and medication-assisted therapy is the better long-term answer to the opioid epidemic, just as quitting smoking, eating healthier and exercising regularly are a better, long-term answer to better cardiovascular health.

All too often in this opioid crisis, many patients with opioid use disorder are seen in EDs across the country. Unfortunately, there are a portion of them that are never seen in the ED because they are found dead. As physicians, we want the opportunity to intervene and help patients, but we need better tools to screen and identify these patients. There are opportunities to proactively identify patients at risk of opiate addiction and its consequences. Thus, it would have been helpful if the HHS had provided guidance in the identifying and screening areas.

That point aside, these HHS recommendations on naloxone rightly identify those who are not typically considered at risk for opioid use related complications, such as those with COPD and obstructive sleep apnea. Physicians that are prescribing narcotics or caring for such patients that have been prescribed narcotics by another provider may want to take the HHS recommendations one step further. This could be done by leveraging patients’ electronic health records to alert health care professionals when a patient is in one of the groups HHS singled out as particularly at high risk for opioid use disorder and is nearing the daily maximum morphine equivalents per day. Once identified, the health care professional can offer the potential lifesaving medication commonly called Narcan that can reverse the effects of narcotics in the event of an overdose. Patients and families need education on opiate addiction, risks of abuse, and how to use the Narcan as well and then fill any information gaps the patient has. For far too long, these “asks” were not happening, or happening at a level that often left the patient feeling demeaned or degraded.

In our ED at The Ohio State University Wexner Medical Center, we have been giving patients who come in for opiate abuse related conditions naloxone when they are discharged. We have also been pushing for more physicians to obtain the waiver needed to prescribe medication-assisted therapy and have partnered with community organizations who are interested in helping patients with opioid use disorders quickly and affordably find the resources they need to get their lives back on the right track. Strategies such as these are working in Ohio. If implemented on a broader level, they may finally move the needle in a significant positive direction on the opioid crisis.