Despite the recent major takedown and public health policies in place, the opioid crisis is still a cause for concern. So much so that US President Donald Trump announced his administration was moving to declare the opioid crisis a national emergency.

Emergency declaration – when does it start and end?

Passing such policies requires bureaucratic follow-up – and in statements issued, following Trump’s comments, neither Health and Human Services Secretary Tom Price nor the White House has clarified when would it take effect. According to the US President, paperwork was underway to make the declaration official.

Authorities that will be leveraged throughout the emergency period need to be stated under the new laws. It would also have to include the possibility of Medicaid and Medicare regulations relaxation as part of the response.

Trump’s announcement followed an “urgent” recommendation from his commission on tackling the opioid endemic. However, experts on emergency and disaster declarations all admit this is uncharted territory. They are uncertain how an opioid crisis can be subjected to an emergency announcement.

Previously, there has been a clear-cut end to emergency states: when a natural disaster-hit area has been cleaned up to a certain point or when an infectious disease outbreak is under control. As the opioid epidemic is not projected to dissolve for years – it is unclear if the declaration would stay in effect for years – or if officials would state from the get-go how to confirm an end for it.

Certain activists expressed their doubts that this declaration would push authorities to crackdown on those using drugs – as opposed to expanding access to treatment and incentivising the use of medication-assisted treatment. Trump has made his stand on utilising the criminal justice system as a vital tool in combatting the crisis.

Rising healthcare costs aggravated by ongoing crisis

In addition to that, a new study has shockingly revealed the cost of treating opioid overdose victims in hospital intensive care units (ICU) jumped 58% in seven years. A total of 162 academic hospitals included in the study recorded an average cost of USD58,500 in 2009, and USD92,400 in 2015. The study also noted an overall increase of ICU admissions by 34%. Also, 23 million admissions of adult patients were included across 44 states throughout the seven-year period. In addition, 21,700 out of the 4 million patients who required ICU admission were for opioid overdoses.

Researchers note the worrying trend highlighted by these numbers: overdose patients are arriving in worse shape, requiring prolonged stays and a higher level of treatment. On top of that, yearly deaths in the ICUs nearly doubled throughout the study period.

Dr Jennifer Stevens, lead researcher and associate medical director of the ICU at Beth Israel shared, “US critical care is awfully good and has a lot of resources, and we’re still not able to save a lot of these lives. That’s really, really concerning.”

The study notes a spike in death around 2012 after a gradual increase for years. Dr Stevens expressed, “I was particularly struck that the mortality was increasing at such an alarming rate. Our data goes through September 2015, and I’m sure the story has continued in an even more complex way since then.”

She added that many overdose patients require a longer period of mechanical ventilation and sedation with numerous others suffering from liver and kidney failure. Among reasons why patients are getting to the hospital in worse states would be the potency of certain opioids, such as fentanyl. Besides that, first responders might be handling severe situations better.

Family physicians cashing in amidst opioid epidemic

A factor that definitely gets in the way of tackling the crisis would be healthcare professionals’ attitude towards the problem. Researchers at Boston Medical Centre found that one in 12 doctors received money from drug companies marketing prescription opioid medications.

Between 2013 to 2015, a total of 68,177 doctors received over USD46 million in payouts from drug companies advocating for powerful painkillers. Scott Hadland, paediatrician and author of the study said, “The next step is to understand these links between payments prescribing practices and overdose deaths.” For many people, “it is very common that the first opioid they’re ever exposed to is from a prescription,” shared Hadland.

Researchers found that fentanyl promotion profited doctors the most. Majority of the fentanyl leading to the increase in deaths is illicitly manufactured overseas and cut into heroin. Tamper-proof versions of the pills – created in response to the crisis – have not been aggressively advertised by companies, noted the study.

“It’s an indicator that opioids are being really heavily marketed for pain,” elaborated Hadland, who’s alarmed by the fact that family physicians accounted for the largest number of payments. Other painkillers such as aspirin and ibuprofen were not as heavily marketed as opioids. MIMS

Read more:
America’s escalating opioid crisis and the desperate struggle for a way back down
US and China’s major moves on opioid crackdown
How one letter led America down the path of opioid addiction