The U.S. House of Representatives Washington, DC

  The Opioid Crisis and Alternatives for Pain Management An Investigative Report Preparedfor: TheUnited States House of RepresentativesU.S.

House of RepresentativesWashington,DC 20515  Preparedby: DrugPolicy Alliance RepresentativeJoshuaMelendezKnoxville,Tennessee 37916   December8th, 2017   The Opioid Crisis and Alternatives forPain Management                                                               i Drug Policy Alliance                                                                                                                                     344 Cumberland Ave                                                                                                                         Knoxville,TN 27916 December 8, 2017 The United States House ofRepresentatives                                                                                U.S. House of Representatives                                                                                                 Washington,DC 20515 Dear Representatives:I am a representative for Drug PolicyAlliance conducting a report on the Opioid crisis. The Drug Policy Alliance,founded in 2000, believes drug policies should be based on science, compassion,health, and human rights; we promote policies and attitudes that reduce theharms of both drug use. Within this document is an investigative reportregarding the opioid crisis and possible alternatives for pain management. Thiscrisis has been an ongoing battle and over the years we have not been winningthis fight. The goal of this report is to examine theorigins of the opioid crisis, the measures that have been taken and how thesehave failed, and what can we do now to solve this issue. This document willdiscuss how Alternative Pain Management treatments may be a viable solution forthe crisis.

The efficacy of these alternative treatments will be explained withcase studies.As representatives of the American people,it should be our best interest to help cure our nation form this crisis. Wecannot continue to let this problem go unsolved. The Drug Policy Alliancewishes to aid our legislators on how we can tackle this problem together. Thisreport can serve as a guide for you all in reforming opioid drug laws andsaving our people from overdose and addiction. Thank you for taking the time to thinkabout how we can go about solving this problem. My colleagues and I hope you take our research and suggestions with anopen mind and that you all begin to see how you all can save Americanssuffering from opioid addiction.  Sincerely, Joshua Melendez                                                                                                                                 Drug PolicyAlliance                                                                                                                       Public Relations Officer   Table of Contents Letter of Transmittal i   Executive Summary ii   Introduction 1   Body/Findings:     Origins of the Crisis 2     Measures Taken 4     Alternatives and Their Efficacy…………………….

.………………………………………….. 6   Conclusions & Recommendations…..………………………………..

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7   References…………………………………………

………………………………………………..7   Works Consulted……………………………………………….

….………………………………………8          The Opioid Crisis and Alternatives forPain Management                                                               ii  The Opioid Crisis and Alternatives for Pain Management Executive Summary There are many Americans suffering from the opioidcrisis and this issue has only gotten worse since it started. For manyAmericans, this addiction is difficult to overcome.  The amount of people who suffer is staggering andthis led members of Drug Policy Alliance think –What led to all this? This isthe question that started our search for the solution. To find the solution,you must first understand how the problem came to be.

During our research, wethen took it a step further to find what had been done by the government tosolve the issue and has it been effective. Finally, we then asked what can westart doing differently to fix the problem.  This investigative report will guide through ourthought process and what we believe is the root of the problem and the natureof the solution. By the end of this report the goal is for you all tounderstand: 1.      What is the Cause of Opioid Crisis?a.       Pharmaceutical Companies lobbying.

2.      What Had been Done in the Past?a.       Pharmaceutical companies assisting in the regulation of opiates. 3.      What Can be Done Now?a.        Revert laws and regulations andseek alternatives for treatment.                  The Opioid Crisis and Alternatives forPain Management                                                               1  Introduction:  Purpose The purpose of this report is to investigate the cause of theopioid crisis, the failed efforts to alleviate the issue, and what can possiblybe done to solve the problem. The report will also recommend alternative painmanagement options to use in place of opiates.

This reportwill guide through our process of thinking and what we believe to be the rootof the problem and how we can go about solving it. By the end of this reportthe goal is for you all to begin to take a course of action that can come tosolid results.  Background Accordingto the Center for Drug Control, in 2016 more than 64,000 deaths resulted fromopioid overdose here in the United States. The number of deaths associated withthe opioid crisis is a growing concern and the Drug Policy Alliance would liketo find out why this is a problem and what we can do about it. Thisreport was commissioned by the Director of Drug Policy Alliance, MarkusTrellis, on October 31, 2017.

 Method of Investigation  Questioners were issued to public on August 15, 2017by the Pew Research Center. They found that nearly half of adults in the UnitedStates have a close friend or family member who’s been addicted to drugs.  Scope This report will be considering how pharmaceuticalcompanies help kick the opioid crisis into motion, how they have helpedimplemented counterproductive drug policies for the crisis, and what we can doinstead to solve this problem.

      The Opioid Crisis and Alternatives forPain Management                                                               2 Origins of the Crisis: During the 1960s and the 1970s many physicians weretrained to reserve opioids for the most serve forms of pain like cancer orend-of-life care. This was the standard practice until the opioid prescribingpolicies changed during the late 1990s when patient advocacy groups and painspecialists, influenced and backed by pharmaceutical companies, began to claimthat doctors were undertreating common forms of pain that could supposedly benefitchronic back and joint pain. Pharmaceutical companies and other financialbackers lobbied at state medical boards to pass a bill that would allow doctorsto more freely prescribe opiates.  They were successful in making many statelegislators make changes to the regulation of opiates; over 20 states saw thesenew guidelines. Many physicians began to believe that opiates were safe fortheir patients and the public also began to hold that opinion. With theimplementation of these new policies, pharmaceutical companies ultimately sawan increase in profits from the sale and distribution of opiates. Largepharmaceutical companies would create multimillion-dollar promotional campaignsthat were aimed directly at the medical practitioners that prescribed them.

 One example would be the popularly prescribed drugOxyContin. This drug was promoted to be less addictive and safer than otherprescribed opiates. This was a largely false claim as OxyContin is highlyaddictive. In 2013 the National Survey on Drug Use and Health found that “peopleaged 18-25 were most likely to report ever having used abused oxycodone (9.9%)compared to 6% of people 26 and older.” That same year the NIDA found that USpharmacies prescribed more than 53 million prescriptions of OxyContin.  To put thisinto perspective, this would mean one bottle for every six people in the US.

Over 65,000 people visited the emergency room due to OxyContin overdose oradverse reactions in 2009. The very drug that was marketed as safe has beenproven to be dangerous; OxyContin is just one example. Despite this, it was thecombination of a more aggressive approach to pain management and marketingefforts that led to the creation of the opioid crisis. Below is a graphdepicting the correlation between the sale of opiates and the number of deaths.         The Opioid Crisis and Alternatives forPain Management                                                               3     The problem behind the opioid crisis is not theabusers, but the pharmaceutical companies that produce and sell these drugs.

Asthe years went on from the policy changes imposed by pharmaceutical companiesthe government official and the public began to take notice and began to takemeasures to solve the issue.              The Opioid Crisis and Alternatives forPain Management                                                               4 Measures Taken: In March of 2016 the Center of Drug Control (CDC)published “The Guideline for Prescribing Opioids for Chronic Pain”. The guidewas created to improve patient care and safety and preventing opioid overdose.The new guidelines consisted of 12 recommendations for physicians prescribingopiates. Below are three points that were key for doctors to follow:  First, non-opioid therapy is preferred for chronic pain.

(Aside from active cancer, palliative, or end-of-life care.) When used, opioids should be added only when their expected benefits are likely to outweigh their substantial risksSecond, use the lowest possible effective dose to reduce the risks of opioid use disorder and overdose. The rule of thumb is “start low and go slow.”Third, doctors should monitor all opioid-using patients closely. This includes, for example, avoiding concurrent use of conflicting drugs, reviewing data from prescription-drug monitoring programs, and having a clear “off-ramp” plan to taper and discontinue therapy.This program was known as the “StartLow Go Slow” and although it seeks to help alleviate the issue, it does verylittle to stop it.

These new guidelines did not seek to stop prescribingopiates but to simply better manage the patients that use them. In 2016 theNational Safety Council conducted a national survey of medical practitionerswho see 70% of their time seeing patients for pain management. In the survey,they found:· 99% of doctors prescribe highlyaddictive opioids for longer than is recommended by the CDC, which is threedays.· 74% of doctors incorrectly believemorphine and oxycodone are the most effective way to treat pain.

· 99% of doctors have seen apill-seeking patient or evidence of opioid abuse, but only 32% usually referthe patient to treatment.·67% of doctors are, in part, basing their prescribing decisions on patientexpectations.It can evidently be seen that these guidelines areineffective from the survey results and are doing little to help solve theopioid crisis. This may be the fact that they are simply”guidelines/recommendations” and this makes for weak policy. Below is a graph depictingthe number of deaths from opioids and it can be clearly seen that from 2016,the creation of the guidelines, to 2017 there has been an increase in thenumber of deaths.      The Opioid Crisis and Alternatives forPain Management                                                               5    Guidelines are not the solution despite the respectableintentions. One speculation based on what happened in the past withprescription policies is that it may be possible that pharmaceutical companiesstill have their influence on politics.

Any policy change regarding the sale ofopiates would decrease the profits made by these companies.  It is in their best interest that these drugsremain on the market despite their high potential for abuse.            The Opioid Crisis and Alternatives forPain Management                                                               6  Alternatives and Their Efficacy: The Drug Policy Alliance believes that the solution is theimplementation of stronger policies that seek to end the opioid crisis entirely.Policies such as these would pose a threat to pharmaceutical companies. Asstated earlier, the problem is the source of these drug and no matter what “guidelines”are put in place the opioid crisis will always remain unsolved. The problem isthat doctors have no alternative treatments to use for pain management.

Infact, many doctors and patients are unaware of alternative methods for painmanagement as mentioned in the precious section. There are many alternativesthat can be effective for managing pain in patients and this could serve as asolution to the problem.  Congress should seek to pass a bill that will revert thechanges made to prescribing polices during the 1990s so that opioids areprescribed less. Alternatives for pain management would then take the place ofwhat was the norm. These alternatives include: ·        Acupunctureo   In a study published in 2007 by theUniversity of Manchester, found that acupuncture was an effective treatment fortemporomandibular joint myofascial pain. The results demonstrated that realacupuncture had a greater effect on the measure of pain than those of thecontrol group. Acupuncture could be one alternative physicians should considerfor pain management this case study is just one of many that show the efficacyof this type of treatment.

 ·        Cannabis o   Ina study published in 2003 by McGill University Health Center, found that 78% ofparticipants reported moderate pain relief after using Cannabis. This studyshows that cannabis could be a viable alternative for pain management due toits ability to alleviate chronic pain without the risk of addiction oroverdose.  ·        Chiropractic manipulation      o  In a study published in 1995 by the New EnglandJournal of Medicine found that 59% of patients saw an improvement in their backpain within 8 days and 90% saw a full recovery within 16 days of treatment.This treatment although aggressive, can be a viable solution for the managementof pain.                                                                              Each of these methods have little to no side effects and haveno potential for harm for the patient.

If doctor were to use these methodsinstead of prescribing opioids we would see a dramatic decrease in deathresulting from overdoes because they are not being prescribed.    The Opioid Crisis and Alternatives forPain Management                                                               7 Conclusionand Recommendations: This report explained how the opioidcrisis came to be, what has been done about it and how it has been ineffective,and how we can solve the problem now by reverting policies and offeringalternatives for pain management. We also saw how pharmaceutical companies hadinfluence on policies in a way that could benefit them and their corporateinterests. In the future, we hope to see that the American Government begins tohelp to put an end to “profit over people”. Large corporations should not have the power to exploit physicians andpatients in the medical system simply to increase their profits. We cannotallow financial backers lobbying for polices that do not have in mind thewellbeing of people here in America; only then will this crisis be solved.

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