“As former governors, we welcome President Donald Trump’s attention to the critical issue of the opioid epidemic and the commission’s work to address the tragic increase in opioid overdose deaths. Each one of us has experienced this issue in our states and the consequences of the epidemic have been felt acutely. Because of our experience at the state level, we offer the following suggestions to the President’s Commission on Combating Drug Addiction and the Opioid Crisis to consider.
“We believe some progress is being made to decrease the number of people misusing and overdosing from prescription opioids. The Centers for Disease Control and Prevention (CDC) reports that prescription opioid (including oxycodone and hydrocodone) involved overdose death rates decreased from 29 percent in 2010 to 24 percent in 2015.1 Federal, state, and local governments have established policies to increase naloxone access, expand prescription drug monitoring programs and mandate their use, and significantly increase treatment dollars from the federal government through the 21st Century Cures Act. These and other responses were appropriate for the crisis as it presented itself in 2015 and 2016 and should continue.
The opioid epidemic of 2017 is different, requiring new federal and state responses that effectively address the increasing overdose death rates, as well as heroin and fentanyl supply increases.
“However, the opioid epidemic of 2017 is different, requiring new federal and state responses that effectively address the increasing overdose death rates involving heroin and fentanyl, as well as heroin and fentanyl supply increases. We are also seeing increasing reports of fentanyl analogs such as the powerful and deadly drug carfentanil being combined with heroin. Data from the CDC confirms that increases in opioid involved overdoses are primarily driven by heroin and illicit fentanyl. CDC data show that, between 2014 and 2015, overdose deaths involving synthetic opioids (which includes fentanyl) increased 72.2 percent and heroin involved overdose deaths increased 20.6 percent.2 In addition, the Drug Enforcement Administration (DEA) reports stark increases in lab testing of fentanyl, per the National Forensic Laboratory Information System (NFLIS). NFLIS reported 14,440 lab submissions testing positive for fentanyl in 2015, up from 4,697 in 2014.”
Given these facts, we offer the following recommendations for the commission’s consideration:
1. Curb Illicit Supply
2. Curb Unnecessary Prescription Opioid Supply
3. Treat and Promote Recovery
4. Educate America
1 Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2015. NCHS data brief, no 273. Hyattsville, MD: National Center for Health Statistics. 2017
2 Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. DOI. Available at: http://dx.doi.org/10.15585/mmwr.mm655051e1.
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