The opioid abuse epidemic is a complex and multifaceted issue that progressed over decades of federal policy and clinical practice that encouraged prescription opioids as the primary option for pain management. But recent media coverage does not provide the full picture and leaves out important details about the epidemic and its origins.
A comprehensive understanding of the multiple drivers of the opioid abuse epidemic is key to moving forward with solutions to address this public health crisis.
1. Starting in the mid-1980s and 1990s, there was a widespread push to treat pain more aggressively. During this time, the American Pain Society launched its “Pain as the Fifth Vital Sign” campaign, which was later adopted by the Department of Veterans Affairs and other healthcare systems as part of standard clinical practice.
2. Public health authorities, leading medical organizations and professional societies have all agreed that opioids have been and continue to be overprescribed. In 2010, opioid prescribing hit its highest point with providers writing 81.2 prescriptions per 100 persons.
3. During the height of the epidemic, the Drug Enforcement Administration (DEA) responded to the demand in opioid prescriptions from healthcare providers by increasing production quotas more than 200 percent between 2006 and 2014.
4. Over the past four decades, there has been a steady increase in drug overdose deaths caused by cocaine, methamphetamine and opioids. The current opioid abuse epidemic has evolved, with heroin and illicitly manufactured fentanyl accounting for the greatest share of drug overdose deaths.
The Pharmaceutical Supply Chain
5. The DEA is the only entity authorized by Congress with full legal authority to regulate and control the supply of controlled substances. As the primary regulator of the supply chain, DEA oversees who handles controlled substances, the supply of them in the market, the flow of these products through the pharmaceutical supply chain and enforcement actions against registrants.
6. Through its Automation of Reports and Consolidated Orders System (ARCOS), the DEA has full line of sight into the total amount of opioid shipments going into any pharmacy in the United States.
7. If there is a suspected diversion by any entity in the supply chain, the DEA receives reports of suspicious orders to investigate. The DEA is the only entity with enforcement power to stop the entire flow of opioids or other medicines to a particular doctor, pharmacy or hospital. Pharmaceutical distributors have reported hundreds of thousands of suspicious orders to DEA over the years. The vast majority of these reports received little to no feedback from the DEA regarding the efficacy or appropriateness of the reporting or whether, in fact, the information was used by DEA in any meaningful enforcement action.
8. Distributors have a limited, yet critical, role in the supply chain. In addition to ensuring that all medicines are delivered safely and efficiently, distributors work with state, local and federal law enforcement to stem diversion before it occurs.
9. The medicines distributors deliver are based only on orders from DEA-licensed pharmacies and hospitals and are tied to prescriptions written by licensed physicians. Distributors do not conduct research, manufacture, promote or prescribe medications, nor do they influence prescribing patterns, the demand for specific products or patient-benefit designs.
10. The misuse and abuse of prescription opioids is a complex public health challenge that requires a collaborative and systemic response that engages all stakeholders.
To learn more about the origins of the opioid epidemic and practical solutions supported by HDA and our members, click here.
ABOUT THE HEALTHCARE DISTRIBUTION ALLIANCE
The Healthcare Distribution Alliance (HDA) represents primary pharmaceutical distributors — the vital link between the nation’s pharmaceutical manufacturers and pharmacies, hospitals, long-term care facilities, clinics and others nationwide. Since 1876, HDA has helped members navigate regulations and innovations to get the right medicines to the right patients at the right time, safely and efficiently. The HDA Research Foundation, HDA’s non-profit charitable foundation, serves the healthcare industry by providing research and education focused on priority healthcare supply chain issues.