Drug abuse – and more specifically, opioid abuse – is a dangerous epidemic that is getting worse. According to the CDC, more than 70,000 American lives were lost due to drug overdoses in 2017. Opioids were involved in two-thirds of those cases (up 16 percent from 2016), killing more people in the year than car accidents or gun violence. In fact, more than 300,000 Americans have died from overdoses involving opioids since 2000 and 130 Americans die every day as a result of the problem. Sadly for far too many patients, opioids were introduced as a frontline strategy to treat another debilitating problem that comes with enormous individual and societal costs – pain. Latest estimates from the CDC indicate 50 million American adults suffer from chronic pain daily or almost daily and nearly 20 million of those suffer from high-impact chronic pain. Acute pain also afflicts far too many, and long-term opioid use often begins with the treatment of acute pain.
Looking at these staggering numbers, it’s no surprise that in October 2017, the U.S. government declared the opioid crisis a national Public Health Emergency. The situation demands swift, comprehensive and collaborative action, and medical technology innovation has a critical role to play. Fortunately, there are numerous medical devices already on the market that are designed to treat chronic and acute pain, and reduce opioid use and abuse through interventions and digital medication management platforms as well as pill dispensing technologies.
For the treatment of acute pain, a number of technologies exist that allow for a targeted and continuous delivery of pain management solutions during and after a surgical procedure which drastically reduces the amount of patient opioid pan medication needed or eliminates it outright. These technologies include Cryoablation, Continuous Peripheral Nerve Block (cPNB) and smart-pump cPNB just to name a few. For chronic pain patients, spinal cord stimulation (SCS) as well as Peripheral Nerve Stimulation (PNS) have proven to be effective alternative treatment options that allow patients to control their chronic pain, reduce or eliminate opioid use and become more active in their daily lives. There are a number of other evidence based, FDA cleared or approved medical technologies that help patients manage their pain along the continuum of acute to chronic pain management. Additionally, medication management and dispensing technologies manage inventory and dosing while smartphone apps offer options to help patients take medications as prescribed. Diagnostic tools can monitor pain medication use and once the course is complete, medication disposal technologies collect unused controlled substances in a safe and secure way.
Along these lines, FDA Commissioner Dr. Scott Gottlieb stated before Congress that there are over 200 cleared or approved medical devices that have components to treat pain, including some very novel devices.
In fact, the FDA launched an innovation challenge last year intended to spur the development of medical devices that could provide novel solutions to detecting, treating and preventing addiction, addressing diversion and treating pain. Eight proposals were selected including therapeutic and diagnostic medical devices intended to treat opioid use disorder, detect and treat overdose, dispense medication and treat pain. The device manufacturers will now receive increased interaction with the Center for Devices and Radiological Health (CDRH) experts, guidance for clinical trial development plans, and expedited review as they work to bring their new and promising innovations to market as part of the FDA’s all-hands-on-deck approach to confronting the opioid epidemic.
Our hope is that developments like these, combined with policies that enable appropriate patient access to these technologies, will help bring medical technology solutions to the forefront of the national conversation on tackling this critical issue, and ultimately reduce over-dependence and reliance on opioids as front or second-line therapy for pain management.
After all, the innovations work. Take a look at retired U.S. Army Sgt. Justin Minyard, a husband, father, and war hero with eight combat deployments in Afghanistan and Iraq – someone who is also recovering from opioid addiction. Minyard was first injured in 2001 at the Pentagon, lifting and moving rubble in the search for survivors after the terrorist attack. He then broke his back falling out of a helicopter on a classified mission. At the time, opioid therapy was the only option available for his pain. In 2011 he was given a spinal cord stimulator that has allowed him to be free of pain medication for over 7 years. His success story, thanks to medical technology, is just one of many.
If we educate physicians, patients, policymakers and others about these technologies while drawing greater awareness to government and private payers about their effectiveness as an alternative,, we can reduce the need for prescribing opioids while providing the holistic, integrated and multi-disciplinary approach to pain management that patients deserve. Groups are working together to identify best practices as well as gaps and inconsistencies in pain management that will hopefully promote greater adoption and access to medical technology for patients suffering from pain. We should build upon this valiant effort.
Working together, this is a battle that we can win.