Responding to the Opioid Epidemic in the United States

Responding to the Opioid Epidemic in the United States As we know, rates of opioid use disorder (OUD) and opioid overdose deaths in the United States have
 reached unprecedented and frightening levels over the past 2 decades. The US Department of Health and Human Services has published data showing that at least 2 million Americans have an OUD involving prescribed opioids and nearly 600,000 have an OUD involving heroin, with about 90 Americans dying every day from overdoses that involve an opioid.1 Few communities have been left untouched by the surge of opioid-related deaths, and the broad reach of the epidemic has blurred the formerly distinct social boundary between use of prescribed opioids and use of heroin and other illegal opioids.2 Responding to this crisis, the US Food and Drug Administration asked the National Academies of Sciences, Engineering, and Medicine (NASEM) to conduct a consensus study to characterize the opioid epidemic and to recommend actions that the FDA and other public and private organizations should take to address it, balancing society's interest in reducing opioid-related harms with the needs of people who are in pain.3 A recently released NASEM report provides convincing evidence that the opioid epidemic in the United States will not be controlled without deploying multiple policy tools that include increased access to a broad range of evidence-based treatments for individuals with OUD and an expanded program of research to develop new nonaddictive treatments for pain.3 Not surprisingly, the bulk of this NASEM report focuses on (1) characterizing the evolving role that opioid analgesics play in pain management, (2) describing the epidemiology of prescription opioid abuse and misuse, and (3) detailing recommended pharmacological approaches to address the problem, such as approval of abuse-deterrent opioids, FDA communication strategies, prescription drug monitoring programs, and state or local policies on prescription drug use. But this NASEM report also devotes some attention to the potentially important role that nonpharmacological interventions might play in responding to the OUD epidemic. This attention is consistent with the recent Centers for Disease Control and Prevention report, CDC Guideline for Prescribing Opioids for Chronic Pain,4 which highlights nonpharmacological treatment options, including physical therapist interventions, as frontline strategies for pain management. The NASEM report notes that physical therapy and exercise often are included in the treatment plan offered to patients who have musculoskeletal pain conditions such as fibromyalgia, arthritis, and back and neck pain. Although the exact physical therapist interventions of most promise are not discussed in detail in the NASEM report, the authors do note that it appears that various types of nonpharmacological strategies can alleviate pain, including aerobic exercise, strength and flexibility training, walking, psychosocial interventions, and manual therapy.5-7 The NASEM report also acknowledges that the exact mechanisms by which physical therapy and exercise affect pain remain unknown. Although I agree with the NASEM report authors that further research is urgently needed to evaluate the optimal type, dosage, and intensity of optimal nonpharmacologic interventions for pain reduction, the report fails to acknowledge that health policy action is urgently needed to alleviate some of the existing barriers to the successful understanding and use of rehabilitation interventions for pain management, such as: The US health care system's long-standing preoccupation with pharmacological approaches to pain management A lack of public and health professional education about the value of nonpharmacological treatments for pain reduction provided by rehabilitation professionals and other clinicians A lack of insurance coverage for the costs of these interventions In response to the understanding that pain is a major public health problem that is complex, multifactorial, and often difficult to effectively manage, PTJ has organized a special issue titled “Nonpharmacologic Management of Pain” to bring attention to the latest research in this area and to help transform the understanding of pain and promote the implementation of evidence-based, nonpharmacological interventions among rehabilitation scientists and clinicians. Scheduled for online release in late March 2018 and print release in May 2018, this PTJ special issue will aggregate and disseminate timely and important research and scholarly perspectives on pain topics. I express my appreciation to Drs Steven George and Arlene Greenspan, who served as co-editors of this important and timely special issue, and I urge readers of PTJ to look for these articles over the coming months. Only with concerted action on all fronts will we be able to address what has become one of the most pressing public health epidemics facing contemporary US society. I believe that all rehabilitation professionals have an important role to play in responding to this crisis. References 1 Center for Behavioral Health Statistics and Quality. Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. HHS Publication No. SMA 16–4984, NSDUH Series H-51. Published 2016. Retrieved from http://www.samhsa.gov/data/. 2 US Department of Health and Human Services. HHS takes strong steps to address opioid-drug related overdose, death and dependence . http://wayback.archive-it.org/3926/20170128023910/https://www.hhs.gov/about/news/2015/03/26/hhs-takes-strong-steps-to-address-opioid-drug-related-overdose-death-and-dependence.html. Published March 26, 2015. Accessed November 7, 2017. 3 Bonnie RJ, Ford MA, Phillips JK, eds. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use . http://nationalacademies.org/hmd/Reports/2017/pain-management-and-the-opioid-epidemic.aspx. Washington, DC: National Academies Press; 2017. Google Scholar CrossRef Search ADS   4 Centers for Disease Control and Prevention. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 . March 18, 2016: 65( 1); 1– 49. 5 Kamper SJ, Apeldoorn AT, Chiarotto A et al.   Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ . 2015; 50: h444. Google Scholar CrossRef Search ADS   6 Kroll HR. Exercise therapy for chronic pain. Physical Medicine and Rehabilitation Clinics of North America . 2015; 26: 263– 281. Google Scholar CrossRef Search ADS PubMed  7 Lee C, Crawford C, Swann S. Active Self-Care Therapies for Pain (PACT) Working Group. Multimodal, integrative therapies for the self-management of chronic pain symptoms. Pain Med . 2014; 15( Suppl1): S76– S85. Google Scholar CrossRef Search ADS PubMed  © 2018 American Physical Therapy Association http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Physical Therapy Oxford University Press

Responding to the Opioid Epidemic in the United States

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Publisher
Oxford University Press
Copyright
© 2018 American Physical Therapy Association
ISSN
0031-9023
eISSN
1538-6724
D.O.I.
10.1093/ptj/pzx120
Publisher site
See Article on Publisher Site

Abstract

As we know, rates of opioid use disorder (OUD) and opioid overdose deaths in the United States have
 reached unprecedented and frightening levels over the past 2 decades. The US Department of Health and Human Services has published data showing that at least 2 million Americans have an OUD involving prescribed opioids and nearly 600,000 have an OUD involving heroin, with about 90 Americans dying every day from overdoses that involve an opioid.1 Few communities have been left untouched by the surge of opioid-related deaths, and the broad reach of the epidemic has blurred the formerly distinct social boundary between use of prescribed opioids and use of heroin and other illegal opioids.2 Responding to this crisis, the US Food and Drug Administration asked the National Academies of Sciences, Engineering, and Medicine (NASEM) to conduct a consensus study to characterize the opioid epidemic and to recommend actions that the FDA and other public and private organizations should take to address it, balancing society's interest in reducing opioid-related harms with the needs of people who are in pain.3 A recently released NASEM report provides convincing evidence that the opioid epidemic in the United States will not be controlled without deploying multiple policy tools that include increased access to a broad range of evidence-based treatments for individuals with OUD and an expanded program of research to develop new nonaddictive treatments for pain.3 Not surprisingly, the bulk of this NASEM report focuses on (1) characterizing the evolving role that opioid analgesics play in pain management, (2) describing the epidemiology of prescription opioid abuse and misuse, and (3) detailing recommended pharmacological approaches to address the problem, such as approval of abuse-deterrent opioids, FDA communication strategies, prescription drug monitoring programs, and state or local policies on prescription drug use. But this NASEM report also devotes some attention to the potentially important role that nonpharmacological interventions might play in responding to the OUD epidemic. This attention is consistent with the recent Centers for Disease Control and Prevention report, CDC Guideline for Prescribing Opioids for Chronic Pain,4 which highlights nonpharmacological treatment options, including physical therapist interventions, as frontline strategies for pain management. The NASEM report notes that physical therapy and exercise often are included in the treatment plan offered to patients who have musculoskeletal pain conditions such as fibromyalgia, arthritis, and back and neck pain. Although the exact physical therapist interventions of most promise are not discussed in detail in the NASEM report, the authors do note that it appears that various types of nonpharmacological strategies can alleviate pain, including aerobic exercise, strength and flexibility training, walking, psychosocial interventions, and manual therapy.5-7 The NASEM report also acknowledges that the exact mechanisms by which physical therapy and exercise affect pain remain unknown. Although I agree with the NASEM report authors that further research is urgently needed to evaluate the optimal type, dosage, and intensity of optimal nonpharmacologic interventions for pain reduction, the report fails to acknowledge that health policy action is urgently needed to alleviate some of the existing barriers to the successful understanding and use of rehabilitation interventions for pain management, such as: The US health care system's long-standing preoccupation with pharmacological approaches to pain management A lack of public and health professional education about the value of nonpharmacological treatments for pain reduction provided by rehabilitation professionals and other clinicians A lack of insurance coverage for the costs of these interventions In response to the understanding that pain is a major public health problem that is complex, multifactorial, and often difficult to effectively manage, PTJ has organized a special issue titled “Nonpharmacologic Management of Pain” to bring attention to the latest research in this area and to help transform the understanding of pain and promote the implementation of evidence-based, nonpharmacological interventions among rehabilitation scientists and clinicians. Scheduled for online release in late March 2018 and print release in May 2018, this PTJ special issue will aggregate and disseminate timely and important research and scholarly perspectives on pain topics. I express my appreciation to Drs Steven George and Arlene Greenspan, who served as co-editors of this important and timely special issue, and I urge readers of PTJ to look for these articles over the coming months. Only with concerted action on all fronts will we be able to address what has become one of the most pressing public health epidemics facing contemporary US society. I believe that all rehabilitation professionals have an important role to play in responding to this crisis. References 1 Center for Behavioral Health Statistics and Quality. Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. HHS Publication No. SMA 16–4984, NSDUH Series H-51. Published 2016. Retrieved from http://www.samhsa.gov/data/. 2 US Department of Health and Human Services. HHS takes strong steps to address opioid-drug related overdose, death and dependence . http://wayback.archive-it.org/3926/20170128023910/https://www.hhs.gov/about/news/2015/03/26/hhs-takes-strong-steps-to-address-opioid-drug-related-overdose-death-and-dependence.html. Published March 26, 2015. Accessed November 7, 2017. 3 Bonnie RJ, Ford MA, Phillips JK, eds. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use . http://nationalacademies.org/hmd/Reports/2017/pain-management-and-the-opioid-epidemic.aspx. Washington, DC: National Academies Press; 2017. Google Scholar CrossRef Search ADS   4 Centers for Disease Control and Prevention. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 . March 18, 2016: 65( 1); 1– 49. 5 Kamper SJ, Apeldoorn AT, Chiarotto A et al.   Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ . 2015; 50: h444. Google Scholar CrossRef Search ADS   6 Kroll HR. Exercise therapy for chronic pain. Physical Medicine and Rehabilitation Clinics of North America . 2015; 26: 263– 281. Google Scholar CrossRef Search ADS PubMed  7 Lee C, Crawford C, Swann S. Active Self-Care Therapies for Pain (PACT) Working Group. Multimodal, integrative therapies for the self-management of chronic pain symptoms. Pain Med . 2014; 15( Suppl1): S76– S85. Google Scholar CrossRef Search ADS PubMed  © 2018 American Physical Therapy Association

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Physical TherapyOxford University Press

Published: Mar 1, 2018

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