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Panel calls on FDA to review safety of opioid painkillers (copy) (copy) (copy)

A state task force is backing a proposal to expand alternative treatments such as acupuncture for certain chronic pain conditions while limiting the use of opioids, even as the proposal draws criticism from people suffering from chronic pain.

Meanwhile, an Ohio city hit hard by opioid overdoses might finally be making some progress against the crisis. The lessons learned there might be useful elsewhere.

These are just two of the many fronts in the nation's fight against opioid abuse. The battle hasn't generated much good news lately, but here's a glimmer: For the first time in years, the number of opioid deaths nationwide has begun to dip, with totals for the preceding 12 months falling slightly but steadily between December 2017 and April 2018.

Despite that good news, the death toll from opioids still is astonishing: According to the Centers for Disease Control and Prevention, the epidemic killed nearly 50,000 Americans last year.

In Dayton, Ohio, however, overdose deaths have plunged, a welcome reprieve in a city where the coroner's office at one point was forced to rent refrigerated trailers because it ran out of space.

Here are some of the factors at work in Dayton, as outlined in a recent New York Times story:

• Ohio Gov. John Kasich decided to expand Medicaid in that state, giving nearly 700,000 low-income adults access to addiction and mental health treatment. (Of course, that comes with a price tag — and states such as Oregon, which also has expanded Medicaid, still are trying to figure out how to pay for that.)

• Ohio has been ravaged by carfentanil, an exceptionally  toxic fentanyl analog, which is 10,000 times more potent than morphine. But for some reason, carfentanil's presence in Dayton's drug scene started to fade in 2017. (In the meantime, however, there are ominous signs that the amount of fentanyl in Oregon's illicit drug pipeline could be increasing.)

• The use of naloxone (better known by the brand name Narcan) has expanded. If administered quickly enough, either by injection or nasal spray, this is the medication that can reverse the effects of opioid overdoses.

• Dayton has put an emphasis on providing services for addicts after treatment ends, from recovery support groups to peer-support networks.

• Law enforcement officers have forged strong connections with public health officials. The Police Department in Dayton, for example, supported plans to set up a needle exchange. And the city won a federal grant for a pilot program that distributes fentanyl test strips to test street drugs for the presence of various fentanyl analogues, like carfentanil.

To be sure, some of those Dayton initiatives are in place in Oregon: The Albany Police Department, to list just one example, has been aggressive about rolling out naloxone to its officers. And the state's Opioid Epidemic Task Force includes representatives from both law enforcement and public health agencies.

But, of course, there's much more work to be done, as witnessed by the continuing controversy over the Oregon task force's recent actions.

The panel last week backed a proposal to provide coverage for five chronic pain conditions currently not covered by the Oregon Health Plan, the state's Medicaid program. 

The idea is to allow patients to receive services such as physical therapy and acupuncture as ways to manage chronic pain that don't involve the use of opioids. (The medical profession's over-reliance on drugs at the expense of other pain-management strategies has been a factor in the opioid crisis.)

The task force also recommended that patients who are already taking opioid doses above recommended limits be required to begin tapering off. That triggered an outcry from chronic pain sufferers and their advocates, who fear that overly stringent limits will leave them with one fewer weapon in their struggle against pain. 

That controversy will continue to play out in Oregon, and at least one thing is for sure: We have a long ways to go in this battle. Progress may be agonizingly slow — but at least it finally looks as if progress might be possible. (mm)

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