The U.S. Opioid Epidemic

Opioid abuse is a serious public health issue. Drug overdose deaths are the leading cause of injury death in the United States.

Our nation is in the midst of an unprecedented opioid epidemic. More people died from drug overdoses in 2014 than in any year on record, and the majority of drug overdose deaths (more than six out of ten) involved an opioid.1 Since 1999, the rate of overdose deaths involving opioids—including prescription opioid pain relievers and heroin—nearly quadrupled, and over 165,000 people have died from prescription opioid overdoses.2 Prescription pain medication deaths remain far too high, and in 2014, the most recent year on record, there was a sharp increase in heroin-involved deaths and an increase in deaths involving synthetic opioids such as fentanyl.

 

Prevention, treatment, research, and effective responses to rapidly reverse opioid overdoses are critical to fighting the epidemic—a top priority for the U.S. Department of Health and Human Services (HHS). In March 2015, HHS Secretary Sylvia M. Burwell announced an initiative targeting three priority areas to tackle the opioid epidemic and help save lives. These include: improving prescribing practices, expanding access to and the use of medication-assisted treatment, and expanding the use of naloxone.

 

The HHS Opioid Initiative targets three key areas that build on efforts to address the opioid epidemic and seek to expand evidence-informed strategies that have the greatest potential for impact. As demonstrated below, much progress has been made in the last year; however, our ability to do more to turn the tide of the opioid epidemic is significantly limited without adequate funding to support expanding access for individuals with opioid use disorder to seek and complete treatment, and sustain recovery.

 

To help achieve the goals of the Opioid Initiative, the President’s budget requests $1.1 billion in new mandatory and discretionary investments over FY 2017 and FY 2018 to expand access to treatment, and prevent opioid misuse and abuse.

The Administration looks forward to working with the Congress to secure the funding needed to provide families and communities with the support they need for opioid abuse prevention and to ensure that treatment is available for those who seek it.

Progress to Date                                                          Next Steps

Opioid Prescribing Practices

In 2014, more than 240 million prescriptions were written for prescription opioids, which is more than enough to give every American adult their own bottle of pills. Raising further alarm, four in five new heroin users started out by misusing prescription opioids.

• The Centers for Disease Control and Prevention (CDC) in March 2016 released its Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care
• As of March 2016, CDC has awarded over $30 million to 29 states to improve safe prescribing practices, such as enhancing Prescription Drug Monitoring Programs (PDMPs), through its Prescription Drug Overdose (PDO) grants. CDC has recently released a funding announcement, which could expand to 50 states by the end of FY 2016.
• In January 2016, the Centers for Medicare and Medicaid Services (CMS) released an Informational Bulletin on Medicaid best practices for addressing prescription drug overdoses, misuse and
• In October 2015, the Administration announced that over 40 provider groups committed to training prescribers in safe prescribing. Since then, more than 60 medical schools and 191 nursing schools have committed to requiring their students to take some form of prescriber education in line with the CDC Guideline. In addition, the President issued a memorandum requiring all federal health care professionals who prescribe opioids to be appropriately

 

Medication-Assisted Treatment (MAT)

MAT is a proven, effective treatment for individuals with an opioid use disorder. MAT has been shown to increase treatment retention, and to reduce opioid use, risk behaviors that transmit HIV and hepatitis C virus, recidivism, and mortality.

• In 2015 the Substance Abuse and Mental Health Administration (SAMHSA) made awards totaling $10.7 million to 11 high-burden states through their Medication-Assisted Treatment for Prescription Drug and Opioid Addiction program. Applications for the next round were due in May 2016, and awards will be made to an additional 11
• The Health Resources and Services Administration (HRSA) awarded $94 million to 271 health centers in March 2016 to improve and expand substance use disorder treatment in underserved
• In December 2015, the Agency for Healthcare Research and Quality announced up to $12 million will be available over several years to fund research projects to support implementation of MAT in rural primary care
• SAMHSA published a notice of proposed rule-making in March 2016 seeking to expand access to treatment through an increase in the number of patients a qualified physician may treat with
• The S. Food and Drug Administration (FDA) in May 2016 approved Probuphine, the first buprenorphine implant for the maintenance treatment of opioid dependence.

Naloxone

Quickly responding to an opioid overdose with the lifesaving reversal drug naloxone is critical. Expanding access to naloxone for first responders and individuals likely to witness an overdose and training health care providers to prescribe naloxone to at-risk patients are essential actions to reverse the epidemic.

• HHS agencies continue to expand access to naloxone through grants to high-need, rural, and tribal communities. For example, in September 2015 HRSA awarded $1.8 million in grant funding to support expanding access to naloxone in 18 rural
• FDA approved a “user-friendly” intranasal formulation of naloxone in November 2015. This followed FDA’s approval of an auto-injector formulation of naloxone in April
• In April 2014, SAMHSA sent a letter to State agencies that administer the Substance Abuse Block Grants (SABG) to clarify that at a State’s discretion, SABG funds could be used to purchase naloxone and cover costs associated with dissemination of overdose kits.

Opioid Prescribing Practices

While actions to address prescription opioid abuse must target both prescribers and high-risk patients, prescribers are the gatekeepers for preventing inappropriate access and providing appropriate pain treatment. The Administration continues to support mandatory prescriber education on the use of opioids for pain management. In addition, the FY 2017 President’s Budget request includes:

• $80 million, an increase of $13 million, to support improved uptake of CDC’s new Guideline among providers and ongoing support to all 50 states and

D.C. through CDC’s prescription drug overdose activities.

• $5 million in funding for the Office of the National Coordinator for Health IT (ONC) to harmonize technical standards in support of integration of PDMPs with health IT systems, improve clinical decision-making, and further the adoption of electronic prescribing of controlled

 

 

Medication-Assisted Treatment (MAT)

While quality MAT is proven to be an effective treatment, the majority of people with an opioid use disorder do not receive it. The FY 2017 President’s Budget request includes:

• $920 million over two years for SAMHSA’s State Targeted Response Cooperative Agreements to support expanding access to MAT for opioid use disorders.
• $15.9 million for SAMHSA’s Pregnant and Postpartum Women (PPW) program, which takes a family-centered approach and provides comprehensive residential substance use disorder treatment, prevention, and recovery support services for pregnant and postpartum women and their families.
• $50 million over two years in National Health Service Corps funding to support nearly 900 health professionals to provide substance use disorder treatment services, including MAT, in areas across the country most in need of behavioral health
• $30 million over two years for SAMSHA to evaluate the effectiveness of treatment programs employing MAT under real-world conditions and help identify opportunities to improve treatment for patients with opioid use disorders.
• $10 million for a Buprenorphine Prescribing Authority Demonstration to expand access to buprenorphine by allowing nurse practitioners and physician assistants to make prescriptions if allowed by State law, in partnership with the S. Department of Justice.

 

 

 

Naloxone

Overdose deaths involving synthetic opioids, including fentanyl, increased by 80% from 2013 to 2014. Adding to the urgency to increase access to overdose reversal drugs, multiple doses of naloxone may be needed to reverse a fentanyl overdose, given its higher potency compared with other opioids. The FY 2017 President’s Budget request includes:

• $12 million for SAMHSA’s Grants to Prevent Prescription Opioid and Heroin Overdose-Related Deaths, which will help equip first responders with naloxone and provide education on its
• $10 million for HRSA’s Rural Opioid Overdose Reversal Grant Program to enable 30 rural communities to purchase naloxone to rapidly reverse the effects of opioid overdoses, and to train licensed health care professionals and emergency responders on its

Drug overdose deaths in the United States continue to increase in 2015

Drug overdose deaths and opioid-involved deaths continue to increase in the United States. The majority of drug overdose deaths (more than six out of ten) involve an opioid.¹  Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled.² From 2000 to 2015 more than half a million people died from drug overdoses. 91 Americans die every day from an opioid overdose.

We now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled,² yet there has not been an overall change in the amount of pain that Americans report.^3,4 Deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have more than quadrupled since 1999.⁵