US Pharm. 2017;42(11):4.

President Trump’s recent address announcing a nationwide public health emergency was long overdue in view of the sobering statistics: In 2016, more than 2 million Americans had an addiction to prescription or illicit opioids. It gets worse: Since 2000, over 300,000 Americans have died from overdoses involving opioids, and drug overdoses are now the leading cause of injury death in the United States, outnumbering both traffic crashes and gun-related deaths.

“The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place,” President Trump said. “If they don’t start, they won’t have a problem.”

While this is no doubt true, it might also be unrealistic. Completely curtailing opioid prescribing would remove the mainstay of pain treatment at the expense of hundreds of thousands of patients legitimately in need of an effective pain remedy.

Besides, the real culprit in opioid-related deaths, he acknowledged in his late-October address, is a specific type of opioid made overseas. The spike in deaths from overdose, he noted, is largely due to the proliferation of fentanyl and fentanyl analogues. To combat this, the Department of Justice’s Opioid Fraud and Abuse Detection Unit secured the first-ever indictments against Chinese fentanyl manufacturers and seized AlphaBay, the largest criminal marketplace on the Internet and a major source of fentanyl and heroin.

In addition, the State Department secured a binding United Nations agreement making it harder for criminals to access fentanyl precursors ANPP and NPP. The action also pave the way for expanded access to telemedicine services, including services involving remote prescribing of medicine commonly used for substance-abuse or mental-health treatment. To really put teeth into this measure, customs officials should step up efforts to interdict illegal shipments of fentanyl on vessels before they even reach our ports.

For its part, the government is focusing on exploring nonopioid options. To help alleviate the overprescribing environment fostered by providers, the National Institutes of Health has initiated discussions with the pharmaceutical industry to establish a partnership to investigate nonaddictive pain relievers and new addiction and overdose treatments, as well as a potential vaccine for addiction.

Furthermore, the Department of Defense, Department of Veterans Affairs, National Institutes of Health, and Department of Health and Human Services are collaborating on a 6-year, $81 million joint research partnership focusing on nondrug approaches to managing pain in order to address the needs of service members and veterans.

These measures will no doubt help stem the rising tide of opioid abuse, albeit modestly. “Emergency” efforts should go further by intensifying the focus on overprescribing by physicians. Without stepped-up oversight at the source, the demand for opioids will continue largely unabated.

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