Health Letter, August 2016
By Michael Carome, M.D.
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On July 13, both chambers of Congress passed the Comprehensive Addiction and Recovery Act (CARA), a bill that purportedly would expand a wide range of federal programs for the prevention and treatment of opioid addiction and abuse. But Congress so far has failed to provide the funding necessary to make these programs a reality. Instead, tucked away within CARA is an expensive and unnecessary handout to the pharmaceutical industry that will do little to curb the opioid abuse epidemic — and may even make it worse.
The urgency of the public health crisis caused by prescription opioid abuse is highlighted by the most recent statistics released by the Centers for Disease Control and Prevention: Overdose deaths involving prescription opioids have increased fourfold since 1999. From 1999 to 2014, more than 165,000 people have died in the U.S. from overdoses related to prescription opioids, including more than 14,000 in 2014. In 2014, nearly 2 million Americans abused or were dependent on prescription opioids.
Drug manufacturers helped feed the epidemic of opioid addiction and abuse by aggressively promoting their products to health care practitioners, often downplaying the drugs’ risks and exaggerating their benefits. These companies profit enormously from the overprescribing of opioids, so the last thing they need is any additional financial incentives from Congress.
Nevertheless, Congress provided incentives to opioid manufacturers in Section 705 of CARA, which would exempt manufacturers of new forms of so-called abuse-deterrent opioids from paying rebates to state Medicaid programs. The Congressional Budget Office estimated that under this provision, certain brand-name opioid manufacturers will receive approximately $75 million in additional Medicaid payments over the next 10 years.
Such additional Medicaid payouts are not needed to encourage manufacturers to develop these drugs. Manufacturers already are heavily promoting abuse-deterrent opioids as the future of opioid pain relief, and state lawmakers are being pressed to pass laws designed to increase the use of these products (see here).
New abuse-deterrent formulations also offer little proven benefit over older opioids; they merely have properties that may, to varying degrees, deter certain types of abuse (for example, crushing and snorting an opioid to achieve a euphoric high). Individuals still can easily become addicted to the abuse-deterrent opioids by taking them as prescribed, and the Food and Drug Administration has stated that it will approve abuse-deterrent formulations without studies showing that they actually prevent drug abuse or reduce addiction rates. Indeed, the new formulations may even fuel the opioid abuse epidemic if promotion of their abuse-deterrent features leads to an overall increase in inappropriate opioid prescribing.
President Barack Obama not surprisingly signed CARA into law. But he should go back to Congress and demand that Section 705 be rescinded and that adequate funding be allocated for the opioid addiction treatment and prevention programs authorized in the legislation. Patients suffering from opioid addiction need the government’s help. The pharmaceutical companies that helped cause the epidemic of opioid abuse don’t.