Issue link: https://beckershealthcare.uberflip.com/i/846928
27 SPOTLIGHT ON THE OPIOID EPIDEMIC Despite differing in their stance on when prescription opioids may be permissible to prescribe, there is a relative consensus among professionals that the medical community and lawmakers must step in to help those af- fected by the epidemic. Boston Medical Cen- ter is using a recently received $25 million donation to fund an opioid abuse treatment center. Legislators in California introduced a bill in March that would issue a one-cent- per-milligram surcharge on prescription opioids. e revenue from the tax would go toward funding drug addiction, treatment and rehabilitation programs across the state. 5. Naloxone. Naloxone, oen referred to by the brand name Narcan, is a medica- tion that works as an opioid antagonist by blocking opioid receptors in the brain from receiving stimulation. e drug is available in several forms, including as an auto-injectable and nasal spray. Hospitals and health systems have partnered with law enforcement and various health departments across the nation to teach and supply officials with the antidote to use in emergency situations. In April, New Mexico became the first state to mandate that law enforcement officers carry the drug with them when out in the field. However, increasing reliance on the medi- cation and an uptick in the number of opi- oid-related overdoses during the past several years has caused the price of naloxone to sky- rocket. In 2005, the price of Hospira's generic version of the antidote rose from less than $1 per milliliter vial to more than $15 by 2014, according to a CNBC report. Similarly, the list price for two doses of Evzio, a naloxone auto-injector delivery device manufactured by Kaleo Pharma, rose nearly 550 percent to $3,750 since the product was first marketed in 2014, according to the report. e pricing trajectory has drawn comparisons to insulin injectors and Mylan's EpiPen, which contin- ues to be the only FDA-approved delivery device available to treat patients experiencing anaphylactic shock. 6. State and federal government response. Despite campaigning on the platform that he will work to address the opi- oid epidemic sweeping the nation, President Donald Trump has yet to introduce federal legislation targeting the issue. HHS Secretary Tom Price, MD, said previous legislation signed into effect under the Obama administration will provide $485 million in grants to combat the epidemic, and that the Trump administration will follow those grants with an additional "half a million [dollar] commitment" in 2018, according to Dr. Price. More than 20 federal lawmakers have also called on President Trump to allocate an additional $9.3 billion in federal funding to help halt the epidemic. Some state governments, however, are insti- tuting a different approach. Two counties in West Virginia have filed lawsuits against drug wholesalers and pharmaceutical retailers, as well as against multiple organizations within the pharmaceutical supply chain, to recoup finances the counties spent to address opioid abuse in their areas. e Cherokee Nation, similarly, filed a lawsuit against three leading pharmaceutical companies — Amerisource- Bergen Drug Co., Cardinal Health and McK- esson Corp. — as well as pharmacy retailers CVS, Walgreens and Walmart, for allegedly flooding their community with highly addic- tive painkillers. Most recently, Ohio Attorney General Mike DeWine filed a lawsuit against the industry's largest drug manufacturers, accusing the companies of engaging in fraudulent and deceptive marketing practices and allegedly fueling opioid addiction in the state. n How a 101-Word Letter in an Academic Journal Helped Fuel the Opioid Epidemic By Alyssa Rege A one-paragraph letter to the editor published in a 1980 issue of the New England Journal of Medicine may have played a much larger role in contributing to the opioid epidemic than researchers pre- viously believed, according to a recent report cited by The Los Angeles Times. The 101-word, five-sentence letter to the editor published in 1980 discussed a study conducted by researchers from the Boston University School of Public Health Boston Col- laborative Drug Surveillance Program. For the study, researchers examined 11,822 hospital patients who were given narcotic pain killers at least once. Out of the 11,822 patients, "there were only four cases of reasonably well-documented addiction in patients who had no history of addiction." Researchers concluded that "despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction." In a new 2017 letter to the editor published in NEJM, researchers argued the opioid epidemic was caused, in part, because physicians "were told that the risk of addiction was low when opioids were prescribed for chronic pain" — a belief that largely rested on information presented in the 1980 letter, despite the fact that the letter contained "no evidence" to back up the conclusion, researchers claimed, according to the report. Authors of the 2017 letter conducted a bibliometric analysis and discovered the 1980 letter was cited roughly 608 times since its publication in 1980 through March 30, 2017. Researchers also discovered that, in addition to being cited so frequently, the information in the letter was often referenced incorrectly or presented in a misleading fashion. Among the 608 papers that cited the original letter, the majority (81 percent) failed to mention that the 11,882 patients involved in the study were treated in a hospital inpatient setting, meaning their experience — and ultimately the authors' finings — may not translate to an outpatient setting, according to the report. Researchers also reportedly saw an increase in the num- ber of citations after the release of OxyContin into the market during the mid-1990s. The continued reliance and citation of such medical literature helped "shape a narrative that allayed prescrib- ers' concerns about the risk of addiction associated with long-term opioid therapy," the authors of the 2017 letter concluded. n