Under the direction of Robert L. DuPont, MD and A. Thomas McLellan, PhD, in March 2017 the Institute for Behavior and Health (IBH) convened a meeting of leaders in addiction treatment, health care, insurance, government and research to discuss the scope and implications of the historic 2016 Surgeon General’s Report Facing Addiction in America. The Surgeon General, VADM Vivek H. Murthy, MD, was an active participant in the meeting.

In the attached brief report issued by IBH, Drs. DuPont and McLellan summarize the core elements of the meeting discussion and recommendations:

–          Supporting the recommendations in the 2016 Surgeon General’s Report, the group agreed that addiction is a serious chronic illness and promoted the development of a modern continuum of public health care for addiction.

–          The group specified that abstinence is an achievable, high-value outcome, both for prevention and treatment.

–          The group recognized the paucity of current models for systematic integration of addiction treatment and general healthcare.

–          The group encouraged the identification of promising models and the promotion of innovation to achieve the goal of sustained recovery, defined as no use of any alcohol or illegal drugs other than medicines that are prescribed and monitored to sustain recovery.

Read the full report here.

The opioid crisis has worsened rapidly since 2010 and continues unchecked. It has been driven by an increase in the supply of opioid substances and expanded use, as well as the known consequences of that use—most troubling, addiction and overdose deaths.

Persistent, long-term use of opioids frequently leads to an opioid disorder—in everyday language, opioid or heroin addiction. Unfortunately, there are no current, national estimates of the extent and intensity of the opioid epidemic. According to the December 31, 2015 White House National Heroin Task Force Final Report, in 2014 there were an estimated 1.9 million people who met diagnostic criteria for prescription opioid use disorder and an estimated 586,000 who met criteria for a heroin use disorder.

An estimate of the extent (or prevalence) of opioid use for the year 2015 can be found in the 2016 National Survey on Drug Use and Health NSDUH. This survey may greatly understate the true extent of opioid use, however, because it is limited to individuals residing in households and willing to participate in the survey. Many troubled drug users cannot or will not be captured by such methodology.

Read the complete study here.

“Available data indicate that the nonmedical use of prescription opioids is a strong risk factor for heroin use. Yet, although the majority of current heroin users report having used prescription opioids nonmedically before they initiated heroin use, heroin use among people who use prescription opioids for nonmedical reasons is rare, and the transition to heroin use appears to occur at a low rate.

The transition from nonmedical use of prescription opioids to heroin use appears to be part of the progression of addiction in a subgroup of nonmedical users of prescription opioids, primarily among persons with frequent nonmedical use and those with prescription opioid abuse or dependence. Although some authors suggest that there is an association between policy-driven reductions in the availability of prescription opioids and increases in the rates of heroin use, the timing of these shifts, many of which began before policies were robustly implemented, makes a causal link unlikely.”

Read the complete study here.

“The number of drug overdose deaths in the United States has increased substantially over the past two decades (1,20). From 2010 through 2014, the number of drug overdose deaths increased by 23%, from 38,329 in 2010 to 47,055 in 2014. The most frequently mentioned drugs involved in these deaths were the opioids: heroin, oxycodone, methadone, morphine, hydrocodone, and fentanyl; the benzodiazepines: alprazolam and diazepam; and the stimulants: cocaine and methamphetamine.”

Read the complete study here.

Testimony of Dr. Debra Houry, Centers for Disease Control and Prevention (CDC) before the

Energy and Commerce Committee, Oversight and Investigations Subcommittee Hearing titled, “Fentanyl: The Next Wave of the Opioid Crisis

March 21, 2017

Read the testimony here.

Going Beyond the Surgeon General’s Report: Redefining the Goals of Prevention, Treatment and Recovery

The close of 2016 saw the release of Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, providing sorely needed direction to a nation grappling with a serious drug epidemic.1 We at the Institute for Behavior and Health, Inc. (IBH) are particularly interested in how close this landmark Report comes to our recommendations about the fundamental goals of youth substance abuse prevention and treatment for substance use disorders. For young people under the age of 21, IBH defines the goal of substance abuse prevention as no use of any alcohol, tobacco, marijuana or other drugs for reasons of health. Similarly, IBH defines the goal of substance abuse treatment as sustained recovery with a standard outcome measure of treatment of no use of such substances for at least five years.

Read the full commentary here.

The U.S. opioid epidemic is continuing, and drug overdose deaths nearly tripled during 1999–2014. Among 47,055 drug overdose deaths that occurred in 2014 in the United States, 28,647 (60.9%) involved an opioid (1). Illicit opioids are contributing to the increase in opioid overdose deaths (2,3). In an effort to target prevention strategies to address the rapidly changing epidemic, CDC examined overall drug overdose death rates during 2010–2015 and opioid overdose death rates during 2014–2015 by subcategories (natural/semisynthetic opioids, methadone, heroin, and synthetic opioids other than methadone).* Rates were stratified by demographics, region, and by 28 states with high quality reporting on death certificates of specific drugs involved in overdose deaths. During 2015, drug overdoses accounted for 52,404 U.S. deaths, including 33,091 (63.1%) that involved an opioid. There has been progress in preventing methadone deaths, and death rates declined by 9.1%. However, rates of deaths involving other opioids, specifically heroin and synthetic opioids other than methadone (likely driven primarily by illicitly manufactured fentanyl) (2,3), increased sharply overall and across many states. A multifaceted, collaborative public health and law enforcement approach is urgently needed. Response efforts include implementing the CDC Guideline for Prescribing Opioids for Chronic Pain (4), improving access to and use of prescription drug monitoring programs, enhancing naloxone distribution and other harm reduction approaches, increasing opioid use disorder treatment capacity, improving linkage into treatment, and supporting law enforcement strategies to reduce the illicit opioid supply.

Read the full report here.