The Opioid Epidemic, and the Role of Medical Technology

Overview

The opioid epidemic can be traced back to the late 1990s, when the medical community began to prescribe opioid pain relievers at a higher rate due to the information and reassurance they received from the pharmaceutical companies that patients would not become addicted to prescription opioid pain relievers. It was this lack of knowledge that led to the increase in physicians prescribing opioid medications, before it became clear that these medications could be highly addictive. The resulting misuse of both prescription and non-prescription opioids provided the catalyst for the opioid crisis to reach the deadly opioid epidemic it is today. In 2015, over 33,000 Americans died as a result of an opioid overdose (including prescription opioids, heroin, and illicit manufactured fentanyl).¹

Fast forward and in the US, more than 115 people die daily after overdosing on opioids. Not only is this a public health crisis, there is an estimated $78.5 billion/year “economic burden” of prescription opioid misuse alone in the US.¹ The economic burden includes but is not limited to; addiction treatment, criminal justice involvement, lost productivity, and the cost of healthcare.  According to statistics from the Substance Abuse and Mental Health Service Administration, the opioid epidemic is so chronic that more than 100,000 health care workers struggle with addiction.²

According to the National Institute on Drug Abuse:¹

• Roughly 21-29% of patients prescribed opioids for chronic pain misuse them. ¹
• Between 8 and 12 percent develop an opioid use disorder. ¹
• An estimated 4 to 6 percent who misuse prescription opioids transition to heroin. ¹
• About 80 percent of people who use heroin first misused prescription opioids. ¹
• Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states. ¹
• The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through September 2017. ¹
• Opioid overdoses in large cities increase by 54 percent in 16 states. ¹

Because most opioid addiction begins with prescription opioids, opioid abuse does not discriminate against age, race, gender or economic profile. At this past MDMA Annual Meeting, Justin Minyard, Executive Director, Operation Shifting Gears, LLC spoke on a panel regarding the Impact of Med Tech on Patient Care. Mr. Minyard is a husband, father, a war hero with eight combat deployments in Afghanistan and Iraq, a veteran, an advocate for chronic pain treatment accessibility and reform and is recovering from opioid addiction. His story provides so many lessons of where the healthcare system failed him, and how advancements in medical technology now allow him to lead a life in recovery. Minyard first injured his back after a building collapsed on him on 9/11, this injury was followed by another broken back after he fell out of a helicopter on a classified mission. These injuries coupled with years of physical strain and back surgeries led physicians to prescribe strong painkillers. It was chilling to hear how quickly addiction can occur when masked in pain treatment. In 2011, Minyard was given a Spinal Cord Stimulator which has allowed him to be free of pain medication for over 7 years. He went from being so impaired by opioid addiction to being able to enjoy taking his daughter to Disney. His story only emphasizes that we have solutions, we just need to advance and implement them better.

The Role of Medical Technology

In order to address the opioid epidemic, we are going to need a village of health care providers, pain specialists, social workers, community centers … etc. In that village, there is a critical role for the medical device community and their role in advancing medical technology.

Many times, the root cause of opioid dependence stems from pain. Often physicians prescribe opioids to relieve acute pain related to injuries or surgery. Moreover, opioids have a dangerous side effect of being highly addictive and prolonged use can lead to opioid addiction and abuse.  However, there is hope for prevention and treatment that relies on innovative medical technology. For example, diagnostic tests that facilitate effective pain management, and minimally invasive devices that would allow for patients to not only recover faster, but to experience less pain and discomfort after surgery.

Just as Minyard benefited from the Spinal Cord Stimulator, medical technology has a critical role to play in reducing opioid addiction and treating chronic pain. AdvaMed outlined some of the new medical technologies and diagnostics that are currently on the marketplace that treat chronic pain and have the potential to be an alternative to opioids.²

• Monitoring Withdrawal and Preventing Overdose²

  • Peripheral Nerve Stimulations (PSN)
  • Auto Injection System
  • Naloxone App
  • Battery-Operated Chip

• Treating Acute Pain²

  • Continuous Peripheral Nerve Block (cPNB)
  • Cryotherapy (Cold Therapy) Treatment
  • Peripheral Nerve Stimulation (PNS)
  • Portable Pain Relief Systems
  • Neuromuscular Electrical Stimulation

• Managing Chronic Pain²

  • Implantable Intraspinal Drug Infusion Pumps
  • Deep Transcranial Magnetic Stimulation (TMS) therapy
  • Pulsed Electromagnetic Field (PEMF) Therapy
  • Radiofrequency Neuroablation
  • Spinal Cord Stimulation (SCS)

• Monitoring Overdose Risk through Diagnostic Tests²

  • Diagnostic Tests
  • Pain medication DNA Insight
  • Blood Testing

• Medical Management Devices and Apps²

  • Medication Management/Dispensing Technology
  • Medication Disposal Technology
  • Medicine Management App

FDA’s Innovation Challenge

In May 2018, the U.S. Food and Drug Administration launched an, “innovation challenge to spur the development of medical devices, including digital health technologies and diagnostic tests that could provide novel solutions to detecting, treating and preventing addiction, addressing diversion and treating pain”.³

“Medical devices, including digital health devices like mobile medical apps, have the potential to play a unique and important role in tackling the opioid crisis. We must advance new ways to find tools to help address the human and financial toll of opioid addiction,” said FDA Commissioner Scott Gottlieb, M.D. “For example, better medical devices that can effectively address local pain syndromes can, in some cases, supplant the use of systemic opioids. This can help reduce overall use of opioids. This innovation challenge is an example of the FDA’s commitment to an all-of-the-above approach to confront the opioid epidemic, including helping those currently addicted to opioids and preventing new cases of addiction. We’re hopeful that in collaborating with public health-minded innovators, we can identify and accelerate the development of new technologies, whether a device, diagnostic test, mobile medical app, or even new clinical decision support software, that can contribute in novel and effective ways to help reduce the scope of this crisis.”³

This challenge is important. However, in order for us to look at the opioid epidemic as a public health crisis of the past, healthcare leaders, along with Congress, need to make sure that the policies and practices of the past, such as overreliance on prescribing opioids for pain management are replaced with evidence-based pain treatments and advancements that have revised reimbursement policies to continue fostering innovation.

References:

1. NIH- National Institute on Drug Abuse. (2018) Opioid Overdose Crisis. Retrieved 6-15-2018 from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis (C)
2. (2018) Combatting America’s Opioid Epidemic with Medical Technology. Retrieved 6-15-2018 from https://www.advamed.org/sites/default/files/resource/combatting_americas_opioid_epidemic_with_medical_technology.pdf (E)
3. FDA News Release (2018, May 30). As part of efforts to combat opioid crisis, FDA launches innovation challenge to spur development of medical devices ‒ including digital health and diagnostics ‒ that target pain, addiction and diversion [Press Release]. Retrieved from https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm609188.htm  A
4. NIH- National Institute on Drug Abuse. (2018) Opioid Overdose Crisis. Retrieved 6-15-2018 from https://www.hhs.gov/opioids/about-the-epidemic/index.html picture