The impact of the nation’s opioid crisis can be measured in many ways, such as the fourfold increase in the number of opioid-related deaths nationally since 1999, including more than 33,000 lives lost in 2015, or in the $42 billion in lost productivity associated with opioid use disorders.
Health care providers and policymakers at all levels are working hard to find solutions. Last year, Congress passed the Comprehensive Addiction and Recovery Act, the first major federal addiction legislation in 40 years. States are testing safe prescribing policies and health insurers are taking steps to provide their members greater access to therapies that combine behavioral health and drug treatment while working with providers and pharmacies on how to best manage patient care. Efforts like these are helping to decrease inappropriate opioid prescribing.
Everyone agrees more needs to be done. A recent report on pain management and the opioid epidemic, from the National Academies of Sciences, Engineering and Medicine, stresses that in addition to addressing opioid-related problems, we must also improve management of chronic pain, a root cause of the opioid crisis.
Given the enormous toll on individuals and our communities, it is vital that we mobilize the research community to generate evidence urgently needed to inform our actions. The NASEM report calls for a range of research to fill evidence gaps.
Unfortunately, there is much we don’t yet know. We need to understand what works most effectively to treat opioid use disorders, reduce people’s reliance on opioids, and prevent addiction. To do that, however, we also need to learn how best to treat chronic pain without opioids and to prevent acute pain from becoming a chronic condition, which leads many people to begin using potent medications. We also don’t yet know how the longer-term outcomes of many potential alternative pain treatments compare with those of prescription opioids.
Comparative clinical effectiveness research is health research expressly aimed at answering such practical, real-world questions. Recognizing the need for more of this kind of research, Congress authorized a new research funder, the Patient-Centered Outcomes Research Institute, in 2010 to fund CER.
PCORI has invested $174 million in 55 patient-centered CER studies related to either noncancer pain management or opioid use. Some are comparing different therapies to determine what’s most effective in treating acute and chronic pain. Others are assessing what works best for preventing unsafe opioid prescribing, reducing opioid reliance, and preventing and treating opioid use disorders, among other crucial questions. These studies will provide information on the types of interventions that may be particularly effective in specific patient populations and settings, not just on which approaches work generally.
Patient-centered CER aims to produce real-world evidence that is immediately relevant to those on the frontlines of the opioid crisis who are making potentially life-changing decisions about which prevention and treatment strategies to use and which policies to enact. It does so by directly involving patients, family caregivers, clinicians, policy makers, insurers like Anthem, and other decision makers in identifying which questions to study and in planning and conducting the research so that it is truly patient-centered.
Results from such stakeholder-driven CER can give decision makers confidence that their choices about pain care and preventing and treating opioid use disorders are going to help. And PCORI is working with stakeholders to ensure that all results reach the decision makers who need them in ways that are most accessible and useful to them.
Working together in these ways, we can have confidence that despite the steadily mounting dire statistics about this epidemic, we can turn the tide by identifying and implementing more effective, more patient-centered approaches to resolving this crisis.
Joe Selby is the executive director of the Patient-Centered Outcomes Research Institute. Sherry Dubester is vice president for behavioral health and clinical programs at Anthem Inc.
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