Major policy changes are needed to resolve the tension between providing adequate pain relief and tackling the epidemic of prescription opioid overdoses, according to drug policy expert Keith Humphreys, PhD. At the recent American Academy of Pain Medicine meeting, he laid out five policies that can achieve a realistic balance.

“Some of the policies are relatively easy to implement, while others involve changing cultural norms, which is much more difficult,” said Humphreys, Professor of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, and a former Senior Policy Advisor at the White House Office of National Drug Control Policy.

According to the National Institute on Drug Abuse, from 1991 to 2009, prescriptions for opioid analgesics increased almost threefold, to more than 200 million. The Drug Abuse Warning Network system, which monitors drug-related emergency department visits and drug-related deaths, found that emergency room visits related to the nonmedical use of pharmaceutical opioids doubled between 2005 and 2009.

The five policies that Dr. Humphreys recommends are:

• Implement prescription monitoring programs. “Some of the initial programs were slow and clunky, but we are now seeing systems, such as the one in New York, that are starting to make a difference,” he says.
• Use the reimbursement power of insurance programs to lock “doctor shoppers” into a single prescriber. “If an insurer sees someone have five doctors writing them pain pill prescriptions, they can designate one provider as the patient’s pain doctor,” notes Humphreys.
• Make prescription recycling a standard practice. “I remember when recycling bottles and cans was considered a strange thing, but now everyone does it,” he says. “Prescription take-back days won’t be fully effective until they become the cultural norm. Dropping off unused pills needs to be something everyone does when they go to the drugstore.”
• Make it easier for drug companies to develop abuse-resistant drugs. “Pharmaceutical companies who are trying to do the right thing need to spend hundreds of millions of dollars to develop a pill that becomes inert when crushed, and then they have to apply for a New Drug Application. We need the Food and Drug Administration to create an accelerated review process for these new formulations.”
• Change opioid-related medical practice. “We need to educate patients and providers that opioids are not the only treatment for pain,” Dr. Humphreys says. “There are other options, including different types of medications and physical therapy. We also need to educate prescribers in the emergency room and in dental offices that they shouldn’t automatically write a 30-day prescription for opioids. They have to start thinking about how much medication a patient really needs.”

With so many people dying of prescription drug overdoses, a response of doing nothing isn’t an option, he emphasizes. “I tell doctors that change is coming, and they can get involved, or else an uninformed policymaker may do it for them, with some potentially bad results.”