New Legislation to Address Opioid Crisis

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A message from Wayne B. Jonas, MD

A message from Wayne B. Jonas, MD

Each day more than 50 people in the U.S. die from prescription pain relievers. When you add the deaths related to heroin, that number jumps to 80 per day.[i]  Last week Congress passed legislation that hopes to reduce those figures. The Comprehensive Addiction and Recovery Act (CARA), S. 524 was passed by the Senate in a nearly-unanimous (92-2) vote.  Having been previously passed by the House, it was recently signed by President Barack Obama.

Update: President Obama signed the Comprehensive Addiction and Recovery Act of 2016 on July 22nd. Read the White House press release.

In these days of bipartisan politics, passage of the act shows the depth and breadth of the opioid crisis. No one is safe from the opioid epidemic as it crosses both racial and socio-economic lines.

What New Opioid Legislation Means for Pain Care and Integrative Medicine

According to the Community Anti-Drug Coalitions of America (CADCA), the Comprehensive Addiction and Recovery Act is long overdue. But with it comes a solution that encompasses what CADCA refers to as the “six pillars.”

“This is the first major federal addiction legislation in 40 years, and is the most comprehensive effort undertaken to address the opioid epidemic, encompassing all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal.” -CADCA

The bill aims to address the link between substance abuse and prison, and expand access to other drugs that can reverse opioid overdoses (naloxone) and treat addiction (buprenorphine).

Now that the legislation has been signed, the challenge remains for the funding issues to be resolved. Critics of the bill site the lack of funding available to make these changes substantial, but note that passage of the legislation is a step in the right direction.

Need for Integrative Options for Pain

Although this legislation starts to effect changes necessary to combat opioid addition, as an addiction doctor in Kentucky said: “Without integrated care and treatment, adequate resources, societal change and… harm-reduction strategies, etc. — without successful implementation of these things we will continue losing.” -Dr. Mina “Mike” Kalfas in an article in USA Today.[ii]

Many of the individuals who inadvertently became addicted to opioids had been prescribed them to combat acute or chronic pain. It’s clear that both doctors and patients need better pain treatment options. This legislation has a major gap for helping people with pain – non-drug treatments that work for pain.

Integrative Medicine for Military and Veterans

The Department of Defense (DoD) and Veterans Health Affairs (VHA) are leading the way in filling this gap. Section 912 of the Act describes how a new Department of Defense Joint Executive Committee (Pain Management Working Group) will include a focus on non-drug treatments for pain. According to Congress, the working group must work collaboratively with other non-DoD groups and employ complementary and integrative treatments to be successful in pain management for the military and veteran population.

This adds to innovate efforts already in progress by the DoD and VHA.

Education, Research and Patient Options

CARA mentions that there will be additional steps in the areas of education, research and patient-centered treatment. Prior to beginning opioid therapy, non-pharmacological treatments will be offered either in place of, or in addition to opioid therapy. CARA also recommends that training in medical school should be provided on evidence-based pain management therapies.

The bill also states the importance of examining the need, evidence for and use of non-pharmacological opioid treatments. This is of special importance to organizations like Samueli Institute and others who work to build the evidence base for healing and wellbeing.

For example, our latest study showed how acupuncture can treat a common pain symptom of Traumatic Brain Injury in our warfighters. Read the article in the American Academy for Pain Management’s Blog: Acupuncture More Effective than Usual Care for Headaches due to Traumatic Brain Injury.  These alternatives to opioids are many and they deserve attention, study and respect within the medical community. An additional example is a series of analyses the Institute conducted showing that massage impacts chronic pain.

As a first step, we are hopeful that passage of this bill shines the spotlight on the needs of doctors, patients and researchers to find and use more integrated and integrative care for pain as we move from treatment to healing.



[i] Center for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Mortality File. (2015). Number and Age-Adjusted Rates of Drug-poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 2000–2014. Atlanta, GA: Center for Disease Control and Prevention. Available at 2014.pdf.