July 31, 2017

Fighting the Opioid Abuse Crisis: Richard Bonnie on the National Committee's Recommendations

Richard Bonnie, Professor of Public Policy at Batten, chaired a national study on the country’s opioid epidemic that provided extensive recommendations for curbing the problem. (This July 13 story is from the UVA Law School, where Bonnie is the Harrison Foundation Professor of Medicine and Law and the Class of 1941 Research Professor of Law.)

“This is an urgent matter,” Bonnie said. “Ninety people die every day of an opioid overdose. We need to muster an ‘all hands on deck’ response to it, and the response needs to be sustained.”

Drug overdoses are the leading cause of unintentional death in the United States, and opioids are the chief contributor. Between 2011 and 2015, overdose deaths from illicit opioids increased from 7,019 to 19,884 — almost threefold.

Reducing the prescribing of opioids has already begun, Bonnie said. But when addicted patients are taken off prescription opioids, they often seek and find substitutes in the illegal market. The number of deaths due to heroin overdose is steeply going up in tandem with the efforts to reduce prescribing, the report shows.

“The epidemic has gotten more complicated because of the intersection of legal and illegal markets,” Bonnie said. The increased use of illegal fentanyl, which is more potent and more dangerous than heroin, is very alarming.

“It took about 20 years for this epidemic to get to the point where we are,” Bonnie said. “And it’s going to take many years to unwind it. So we really need to stay on this. It can’t be one of those things with a short political attention span. It’s very serious and it’s going to be very serious for a long time.”

The report urges the FDA to conduct a systematic review of all opioids currently on the market.

“We need a broader regulatory approach and more aggressive monitoring of what happens in practice after the drugs are on the market,” Bonnie said.

An ad hoc committee of pain-management, opioid-misuse, and other public health experts convened in March 2016 at the request of the Food and Drug Administration to examine two challenges that fuel the epidemic: the need for opioids to treat pain and the need to reduce harms when the drugs are not used as intended. (UVA Law Professor Margaret Riley also served on the committee.)

The committee’s presented its analysis and recommendations to the FDA and at several Congressional briefings July 12, and they released the report to the public July 13.

The committee recommends using evidence-based medical treatment for almost 2.6 million people who have “opioid use disorder,” and the committee emphasizes that providing access to treatment is an “ethical imperative.”

But medications for treating addiction can be expensive. Congress’ consideration of expanding Medicaid to help combat the problem is vitally important, Bonnie said.

“It’s actually quite heartening that we have bipartisan support for doing something about this problem,” he said.

Release of the Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse report was accompanied by an invited “viewpoint” column in the Journal of the American Medical Association.

In the report, the committee urges efforts to educate prescribers, patients and the general public on alternatives to opioids, as well as the risk factors of their use.

The report urges states to remove financial and legal impediments to access to naloxone, the drug used to save the lives of people who have overdosed.

The committee recommends additional research into non-addictive analgesic alternatives to opioids and non-pharmaceutical options such as massage therapy and yoga.

Additionally, an expansion of the FDA’s regulatory vision will aid the agency in systematically considering public health concerns when making their decisions, Bonnie said. To this end, the committee has recommended specific ways in which the agency can incorporate concerns about the risk of addiction, overdose, diversion of drugs from the health care system and other harms into their decision-making process.

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Separately, Bonnie is serving on the leadership team of the newly formed Virginia Criminal Justice Policy Reform Project, which seeks to research — and encourage the adoption of — policies aimed at:

  • improving the fairness of criminal adjudication
  • preventing wrongful convictions
  • reducing recidivism
  • reducing costs
  • diverting low-risk offenders from jail or prison, and
  • easing societal re-entry for the formerly incarcerated.

UVa Law School professor Brandon Garrett leads the project, while UVA Law professor John Monahan also serves on the leadership team.

Bonnie has co-authored leading textbooks on criminal law and public health law. His first book, The Marijuana Conviction: A History of Marijuana Prohibition in the United States, was first published in 1974 and was republished in 1999.

Bonnie received the the University of Virginia’s highest honor, the Thomas Jefferson Award, in 2007. 

(A extensive biography of Bonnie’s reserach work and achievements is here.)

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Professor of Law, Medicine, and Public Policy; Director of Institute of Law, Psychiatry, and Public Policy
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