Contributor: Congress Must Do More to Cover Nonopioid Alternatives

Preventing addiction is key to ending the opioid epidemic—2020 alone saw more than 93,000 overdose deaths—as are expanding access to treatment, promoting recovery, and building a multifaceted strategy that incorporates nonopioid alternative and their coverage by providers. Although appropriate in certain situations, opioids are not a one-size-fits-all approach.

When it comes to the severity of our nation’s opioid crisis, the statistics are staggering: Since 1999, over 800,000 Americans have died from a drug overdose, the majority of cases involving opioids, CDC statistics show.

The scale of the crisis is widely understood by Washington, but that doesn’t make it any less tragic—especially for the millions of Americans who have lost a friend or loved one to the disease of addiction. Nor has it led to long-lasting progress against the nation’s opioid epidemic. Whereas overdose deaths appeared to dip before the pandemic, the COVID-19 crisis has only made the situation worse: In 2020, the United States suffered over 93,000 overdose deaths—the highest number in our nation’s history.

Although the opioid crisis in the United States will require a multifaceted strategy to save lives, expand access to treatment, and promote recovery, preventing addiction is also key for millions of Americans. We may not be able to bring back those whose lives were tragically cut short, but by implementing smart policies that improve access to nonopioid pain-management alternatives, we can help support a generation of patients to live long, healthy, fulfilling lives.

It’s no secret that the current crisis was fueled by prescription opioids. Failing to appreciate their addictive qualities, combined with dishonest business practices that led to many high-profile lawsuits and trials, created a surge of opioid diversion, misuse, and abuse. For 2006 to 2014, Drug Enforcement Administration records show a shocking number of pills flooding into communities across the country.

In Charleston County, South Carolina, for example, enough opioid prescriptions were distributed to give every single resident 255 opioid pills every single year. Many communities in the West and in Appalachia were similarly affected, causing addiction and drug overdose rates to skyrocket. As oversight became more stringent, the main drivers of the crisis became heroin and, most recently, synthetic opioids such as fentanyl.

But make no mistake: The risks of overprescription still loom large. Following surgery, the average American receives over 80 opioid pills to manage pain, whether the painkillers are truly needed or not. In addition, although the opioid prescription rate has fallen in recent years, the number of opioids prescribed remains well above the maximum recommended prescription for some of the most common procedures.

According to the CDC, more than 153 million opioid prescriptions were dispensed in 2019—for 46.7 prescriptions per 100 persons—and in 5% of counties nationwide, there are enough opioid prescriptions to give one to every single man, woman, and child for powerful painkillers. In a handful of hard-hit areas, the opioid dispensing rate was 6 times the national average. The pandemic has only complicated the crisis.

Not only are national overdose deaths at record highs, but according to a recent study published in Nature, COVID-19 survivors have been shown to have an increased incident use of opioids in the 6 months after their diagnosis. The study found that for every 1000 individuals with long COVID, health care providers wrote 9 more prescriptions than they would have in the absence of the pandemic. With over 3 million Americans suffering from the effects of long COVID, these additional opioid prescriptions risk inflaming the current crisis.

We need a better approach.

Although opioids are appropriate and necessary in certain circumstances, they are far from a one-size-fits-all approach. Patients and providers must have the choice of using nonopioid alternatives—and that means removing barriers and expanding patient choice to safe and effective drugs, devices, and therapies. Unfortunately, under current law, CMS disincentivizes providers from offering nonopioid alternatives in surgical settings.

Adjusting the law so that opioids are not unduly incentivized over other pain management approaches would go a long way in preventing opioid overprescription, abuse, and addiction. To implement this commonsense policy, a bipartisan group of lawmakers introduced the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (S 586/HR 3259). If enacted into law, this bill would ensure that FDA-approved nonopioid-based approaches to pain management are appropriately covered and accessible to patients and providers.

As the NOPAIN Act continues to garner strong bipartisan support, and as the nation’s overdose death rate continues to surge, I urge all members of Congress to sign and pass this legislation quickly.