The Washington Post: The Health 202: Here’s how to tell when the opioid crisis is starting to recede

Trump signs opioid bill

There was lots of back slapping and handshaking at the White House yesterday as President Trump signed Congress’s bipartisan bill targeting the country’s opioid crisis.

Yet the problem of addiction and overdose is still raging across the United States. There are hints the epidemic could be starting to recede, but it’s far from certain that we’ve turned a corner on a public-health scourge that causes around 70,000 deaths each year.

That’s not to say Congress and the administration aren’t at least tryingto make a dent in a big problem. Democrats and Republicans alike cheered the opioids measure they passed this month, which contains a smorgasbord of provisions supporting treatment programs, stemming the influx of fentanyl into the country and trying to reduce opioid overprescribing, while stopping short of supplying a long-term funding stream to tackle the issue.

Trump — noting that it has been a full year since he first declared opioid abuse a public-health emergency — spoke yesterday in uncharacteristically measured terms about the opioids legislation. He promised it would deliver big changes but acknowledged the problem won’t disappear overnight.

“You won’t see the results immediately. But you’ll see the results in the future and very quick future,” the president told a gathered audience.

Trump’s top health official, Health and Human Services Secretary Alex Azar, was also optimistic — but cautiously so — in a speech he gave Tuesday at the Milken Institute Future of Health Summit.

“We are so far from the end of the epidemic, but we are perhaps at the end of the beginning,” Azar said. He also tweeted about it:

How will we know when the opioid crisis has reached the end of its beginning? The most obvious way is examine deaths from overdose. And there’s some good news there. Provisional datafrom the Centers for Disease Control and Prevention indicates overdose deaths from all kinds of opioids might be dipping slightly, after massively spiking through 2016 and 2017. They’re down nearly 3 percent after reaching a high last November.

But the numbers are still grim: An estimated 69,000 people in the United States still die of opioid overdoses every year — considerably more than the approximately 40,000 annual deathscaused by motor vehicle accidents.

“Plateauing at such a high level is hardly an opportunity to declare victory,” Azar acknowledged. “But the concerted efforts of communities across America are beginning to turn the tide.”

There are several other indicators experts use to measure the extent of opioid abuse in the United States. The goal, Brandeis University psychiatrist Andrew Kolodny told me, is to get a good sense of how many people are newly struggling with opioid addiction and how many opioid users are getting treatment.

“It’s too soon to tell, and even if we are turning a corner there’s nothing to celebrate here because we still have an extraordinarily high overdose death rate,” Kolodny said.

Here are a few key indicators to watch in gauging the state of the crisis:

1. How often doctors are prescribing opioids.

There’s some dispute over this. The CDC says the prescription rate fell last year to its lowest level in a decade, at 58.7 opioid prescriptions per every 100 people (the agency says the rate peaked at 81.3 prescriptions per every 100 people in 2012). Similarly, an April report by the firm IQVIA found a 22 percent decrease in opioid prescriptions nationally between 2013 and 2017.

But the Mayo Clinic released a study in August suggesting that little has changed in the past five years on prescription opioid use. Researchers found that while prescriptions seemed to be leveling off, they weren’t decreasing among most groups of patients.

2. How often doctors are prescribing overdose reversal medications.

More prescriptions for naloxone — an overdose reversal drug — and medications used in treating patients with opioid addiction are other important indicators of where we are on the problem.

Azar said naloxone prescriptions are up 350 percent — a figure citedearlier this month by Surgeon General Jerome Adams, who also said retail dispensing of the drug was up 70 percent. Researchers have found that naloxone prescriptions paid for by Medicaid increased 1,109 percent between 2011 and 2016.

The secretary also said prescriptions for buprenorphine and naltrexone — two medications to treat opioid abuse — are being prescribed 21 percent and 47 percent more frequently, respectively. Those figures seem to be supported by research.

3. How many babies are born addicted to opioids.

Neonatal abstinence syndrome (NAS) is what some babies experience after being born to mothers addicted to opioids. It’s a heartbreaking problem, and one the administration is vowing to tackle. On Tuesday, HHS rolled out a pilot program to help mothers with opioid addiction and their children, implemented through Medicare’s innovation center.

And there’s no good news yet on this front. Using its most recent statistics available, the CDC says the incidence of NAS increased about 400 percent nationally from 2000 to 2012. And it’s reasonable to believe the problem has only gotten worse, as opioid abuse rates have only increased in the past six years.

4. How many people are dying from fentanyl and heroin.

Here, too, is some bad news. Fentanyl, a synthetic opioid that is many times stronger than heroin, has exploded onto the scene and causes an increasing share of overdose deaths. The CDC estimated there were nearly 29,000 synthetic opioid overdose deaths in September 2017 and more than 30,000 such deaths in March of this year. Heroin use is slightly up as well.