The deepening opioid epidemic, which may have worsened during the COVID-19 pandemic, led Stanford University School of Medicine and The Lancet to form a commission to study the crisis.
In the article published in The Lancet, the commission called for changes to meet urgent public health needs, including banning direct marketing to prescribers of drugs, decoupling pharmaceutical industry donations to professional associations and universities from control over medical education, and encouraging health accreditation bodies to refuse to accept pharmaceutical money.
“Millions of people have become addicted to opioids, which has triggered increases in other disorders, disability, family breakdown, unemployment, and child neglect,” Jonathan Caulkins, PhD, professor of operations research and public policy at Carnegie Mellon University’s Heinz College and a member of the commission, said in a statement.
In the report, the commission provided a brief history of opioid use and addiction in North America, described the landscape of opioid overdose, and included 7 categories of recommendations. These are:
- Building integrated, well-supported systems for the care of substance use disorders, which includes standardized addiction care within health and social care systems and expanding private and public insurance to adequately finance substance care of opioid use disorder.
- Creating healthy environments that can yield long-term declines in addiction, such as improving the quality of excess opioid disposal programs and integrating substance use prevention programs with programs targeting other problems.
- Improving the criminal justice system’s care for individuals addicted to opioids. This includes offering addiction-related health services during and after incarceration and not incarcerating individuals for simple possession or use of illicit opioids. The commission also recommended ending collateral penalties for drug-related crimes and penalties for substance use during pregnancy.
- Recognizing the benefits and risks of opioids in the drug approval process by giving more consideration to the risk of diversion to illegal markets and unsupervised use, in addition to risks when the drugs are taken as directed. The commission also recommended addressing chronic pain by implementing strategies for pain management, conducting clinical trials on the benefits and risks of opioids, and improving the impact of policies that restrict opioids.
- Preventing opioid crises beyond North America by not allowing US pharmaceutical producers to export corrupt and fraudulent opioid promotion practices abroad, and distributing free, generic morphine for analgesia to hospices and hospitals in lower-income nations.
- Reducing the influence of the pharmaceutical industry on prescribers’ practice and education. This includes banning direct-to-prescriber marketing of drugs and encouraging Congress to remove the tax deductibility of pharmaceutical marketing.
- Stimulating innovation in response to addiction by implementing policies that correct for failures in patent law and marketing incentives, prioritizing non-opioid medication development and opioid molecule redesign, and weighing international data more heavily in medication approval decisions.
The commission, formed in fall 2019, comprises 18 members, who have expertise in addiction, law, neuroscience, pain medicine, public health, and other areas of interest.