The opioid crisis continues, and now, drug manufacturers are facing more scrutiny than ever for their role in the epidemic. Massachusetts Attorney General Maura Healey is suing Purdue Pharma, maker of OxyContin, and the family that owns the company, the Sacklers. But a new study in the journal JAMA Network Open by researchers at Mass. General and Boston Medical Center suggests that cutting down on prescription opioid use for non-medical reasons won’t do much to stem the crisis. One of the study's authors is Dr. Marc LaRochelle of Boston Medical Center. He spoke with WGBH All Things Considered anchor Barbara Howard. This transcript has been edited for clarity.
Barbara Howard: Your study paints a pretty dark picture of the where the opioid epidemic is headed. It's as if the horse is out of the barn, in terms of opioid prescriptions.
Dr. Marc LaRochelle: I think that might be fair to say. A major target of policy practice in healthcare delivery efforts was to stem the tide of opioid prescribing and inappropriate opioid prescriptions. But I think what we've seen in this study is that the number of people who already have an active opioid use disorder, either from prescription opioids or illicit opioids, is quite high. And those individuals are not going to have those use disorders cured by reducing the supply of prescription opioids.
Howard: But controlling the supply of prescribed opioids will maybe stop the next generation of potential addicts?
LaRochelle: That's a very good point. The time span of our study was really looking over the next 10 years, from 2015 on. So in that medium-term, we're not seeing a huge impact of reducing new people from using prescription opioids in non-medical ways, and part of that is because the natural history of developing a use disorder takes time.
Howard: When you say a use disorder, are you talking about moving on from prescribed opioids onto heroin or fentanyl?
LaRochelle: Yes. What we're talking about here is moving beyond use in a controlled medical setting to where the use of that medicine is no longer for medical reasons.
Howard: Are the crackdowns we're seeing on opioid manufacturers by the likes of Massachusetts Attorney General Maura Healey too little too late, at this point?
Read more: Healey Seeks Justice For Opioid Victims, Accountability From Family Behind Purdue Pharma
LaRochelle: I don't think it's too little too late. We find estimates around 3 to 5 percent, depending on the scenario, in the number of deaths that could be averted. Given the number of people who are dying, that's not inconsequential.
We're not saying that those aren't worth trying. The whole point of what we think the findings are here is that the efforts need to extend well beyond our current attempts at stemming the prescription opioid supply, and really refocusing on the people who are currently using opioids — either prescription opioids or heroin — to make sure that those people aren't going to die.
Howard: What can be done, then?
LaRochelle: We would suggest, first, policy and public health reform efforts to improve access to evidence-based treatment. We know that medications for opioid use disorders such as methadone and buprenorphine are highly effective, but there are a lot of barriers to patients accessing them. Second, make sure that we reach out to people who are using opioids and who may not yet be ready to access treatment and amplify our harm reduction efforts. Through counseling and education, I think there are ways to reduce the potential risks of opioids for people who choose to use them, like making sure the reversal agent naloxone is widely available. We counsel our patients that if they're going to use, they shouldn't use alone, they have naloxone available, and they call for help.
Howard: Given your study, given all that you know, and given your statistics, will we ever get to the other end of this opioid epidemic?
LaRochelle: I think we will. I think there's reason for optimism and hope. It's really hard to always predict the future. No one saw fentanyl coming, and despite all our efforts, things got worse. We're worried about if there's another fentanyl analog out there, or some other super potent opioid agonist. I think our way to really starting to reverse this is to embrace harm reduction and treatment, so that we can give people who are really struggling reason for hope and optimism that their lives can be better.
Howard: That's Dr. Marc LaRochelle of Boston Medical Center. He's one of the authors of a new study out in the journal JAMA Network Open which shows that at this point, reducing the number of people who start on prescription opioids for non-medical reasons won't do much to stem the opioid epidemic. This is WGBH’s All Things Considered.
