Pubdate: Fri, 21 Aug 2015
Source: Washington Post (DC)
Copyright: 2015 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491

THE HEROIN EMERGENCY

Controlling Prescription Opioids Can Help Curb the Epidemic.

NOT EVEN the federal government can solve the nation's growing heroin 
epidemic on its own, but it could always do more. That's probably the 
best way to think about the new anti-heroin initiative unveiled by 
the White House on Monday. A one-year, $2.5 million plan to track the 
flow of drugs through the Northeastern states and other 
"high-intensity" regions certainly can't hurt; but the White House 
isn't pretending that its new initiative will conquer the problem and 
nor should anyone else.

Two out of every 1,000 Americans were addicted to heroin in 2013, 
according to the Centers for Disease Control and Prevention, double 
the rate in 2002. There were 8,200 heroin-related overdose deaths in 
2013; the number of such deaths per 100,000 people nearly quadrupled 
between 2002 and 2013, the CDC reports. These figures are especially 
troubling given that heroin abuse increased at a time when the United 
States made significant progress against so many other stubborn 
social ills - including drunken driving and teen pregnancy.

Even more frustrating, the heroin epidemic is itself an unintended 
consequence of what had previously been thought to be a great medical 
advance: the rise of prescription opioid pain medications. Massively 
prescribed, often for routine ailments rather than cancer or other 
excruciating diseases, these painkillers addicted hundreds of 
thousands of people, many of whom eventually turned to chemically 
similar, but cheaper, heroin. Prescription-opioid addicts are the 
highest-risk group for heroin addiction, according to the CDC, and 
controlling the flow of prescription opioids is, accordingly, the 
most important thing that government-federal and state-can do to prevent it.

One key program is the use of state-level electronic databases to 
track the dispensing of opioids; additional federal funds for these 
prescription drug monitoring programs were part of $133 million in 
new spending to curb opioid overprescription in President Obama's 
fiscal 2016 budget, and those dollars would probably do as much or 
more to fight heroin abuse than anything specifically targeted at heroin.

It would also help if the federal government could find away to speak 
with a single voice on this issue. In 2013, the Food and Drug 
Administration baffled many officials in heroin-ravaged states by 
approving a new opioid despite a negative recommendation from its own 
expert advisory panel. And on Aug. 13, just days before the White 
House rolled out its latest anti-heroin plan, the FDA approved the 
powerful opioid OxyContin for use in patients as young as 11. Sen. 
Joe Manchin III (D-W.Va.) denounced this as a "reckless act." The FDA 
noted, defensibly, that the approval may actually inhibit 
overprescription because it provides more definitive guidance on 
dosing and efficacy to physicians who were already free to give 
opioids to young patients "off-label." Nevertheless, Mr. Manchin was 
understandably worried that the FDA did not appoint an advisory panel 
to screen the proposal and that its decision could be seen as a green 
light for wider pediatric use by doctors lacking the time or 
inclination to educate themselves on best practices.

The last thing this country needs is more conflict and confusion 
about how and when the gateway drugs for heroin enter the marketplace.
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MAP posted-by: Jay Bergstrom