Panel warns of further opioid devastation, urges new initiatives to curb epidemic
Unless “urgent interventions” occur, North America could see 1.2 million additional opioid overdose deaths by 2029, according to a commission formed in response to rising opioid-related mortality rates.
The “increasingly devastating opioid crisis” in the United States and Canada could spread worldwide unless far-reaching, thorough measures are taken, the Stanford-Lancet Commission wrote.
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“Although COVID-19 has seized the attention of policy makers and the public, the epidemic of addiction and overdose that preceded it remains unabated and seems to have been worsened by the consequences of COVID-19,” Keith Humphreys, PhD, chair of the commission, and colleagues wrote.
The commission, which included experts in behavioral health, informatics, addiction and several other specialties, noted that:
More than 600,000 opioid overdose deaths have occurred in the U.S. and Canada since 1999. That total exceeds the number of deaths that occurred in those nations during World I and World War II combined.
The U.S. mortality rate for opioid toxicity in 2020 was nearly 22 per 100,000 people. In Canada, it was almost 17 per 100,000 people. “Both of these rates exceed the mortality rate at the peak of the HIV/AIDS epidemic in these countries,” the commission wrote.
In the U.S., the incidence of fatal opioid overdoses increased 37% from 2019 to 2020. Provisional CDC data showed there were 75,387 U.S. deaths from opioid toxicity in the 12 months that ended May 30, 2021.
The commission proposed several recommendations to lower the number of opioid-related deaths and curb the opioid epidemic globally, such as:
- “preventing opioid manufacturers from inciting overprescribing and strengthening regulatory systems in all nations to prevent opioid crises;"
- encouraging “opioid stewardship in medicine” by utilizing prescription drug monitoring programs, creating safer prescribing protocols, using opioid agonist therapy and improving access to naloxone;
- endorsing strategies that help physicians recognize their “implicit, conscious and unconscious" biases against treating patients with opioid use disorder; and
- establishing, assessing, promoting and repeatedly updating “core competencies for pain care education, licensure and certification at the undergraduate and graduate levels;” and
- promoting efforts to prevent or treat opioid addiction in unconventional settings.
The opioid epidemic was years in the making, and it may not end quickly either, according to Humphreys, who is also a health policy associate and professor at Stanford, and colleagues.
“It took more than a generation of mistakes to create the North American opioid crisis,” they wrote. “It might take a generation of wiser policies to resolve it. Such policies will have long-lasting gains if they curtail the power of health care systems to cause addiction and maximize their ability to treat it.”
In a related editorial, the editors of the Lancet cautioned that the opioid epidemic could spread “without reigning in deceptive marketing and prescribing practices and international funding for subsidized generic morphine for low-income countries.”
“The risk of global spread is greater where COVID-19 has ravaged health systems, where pain needs in resource-limited settings go unmet, and where corporations look for new markets, but are left to self-regulate,” the authors of the editorial continued. “To manage pain, greed must be managed as well.”
References:
Humphreys K, et al. Lancet. 2022;doi.org/10.1016/ S0140-6736(21)02252-2.
The Lancet. Lancet. 2022;doi:10.1016/S0140-6736(22)00200-8.
The Lancet: Over 1.2 million additional opioid overdose deaths expected in North America by 2029, with epidemic set to expand globally, experts warn. https://www.eurekalert.org/news-releases/941988. Published Feb. 2, 2021. Accessed Feb. 2, 2021.