By Chris Adams

When it comes to trying to reverse the negative trends in opioids use, what might work? Have researchers pinpointed the best strategies to do so?

In a session with journalists at a National Press Foundation program, Dr. Caleb Alexander laid out the latest evidence – even as he acknowledged the evidence for some of the strategies is still coming in.

Alexander, an associate professor of epidemiology and medicine at the Johns Hopkins Bloomberg School of Public Health, talked about the standard approaches for preventing opioid abuse, as well as for proper use of opioids in pain management.

He reviewed the guidelines from the U.S. Centers for Disease Control and Prevention for appropriate opioid prescribing. That includes not using opioids for routine or first-line therapy for chronic pain; using caution when increasing dosages; limiting prescriptions to what’s only needed for acute pain, with three to seven days’ worth usually enough; and avoiding concurrent use of opioids and other drugs, such as of anti-anxiety drugs benzodiazepines.

He detailed the frequency of overdose among people prescribed opioids for pain, reviewing the studies that have tracked it.

He did talk about “glimmers of hope” – some indications that it might be possible to slow or reverse the negative opioids trends. Among the factors he’s seen:

  • A reduction in prescription opioid volume
  • A decline in prescription opioid misuse among youth
  • A plateauing of deaths from prescription opioids
  • Some states that have seen a leveling of total opioid deaths
  • Increased delivery of medication-assisted treatment
  • Increased naloxone dispensing from pharmacies
  • Increased harm reduction programs such as syringe exchanges

“We will turn this around,” he said. But it will take a while.

“Unfortunately, despite all the stuff that’s going on, change is slow,” he said. He ticked off a list of programs and interventions underway from health systems, government entities and researchers but noted “we may not see the effects of them for a long time.”