ASN, Peer Societies Advocate for Safe Alternatives to Manage Pain

Policymakers and public health officials are sounding the alarm about the opioid overdose crisis nationwide. More than 115 people die each day due to opioid-related drug overdoses, and the Department of Health and Human Services (HHS) Secretary Alex Azar has made combatting this epidemic one of his top priorities. White House and HHS officials have met with representatives of the American Society of Nephrology (ASN) and peer medical societies to discuss strategies to confront the epidemic and have also launched a public service campaign to help educate Americans about the highly addictive nature of opioids.

The Trump administration has launched the first phase of its long-promised anti-opioid media campaign as part of its efforts to address the opioid crisis. The first ads to run in the campaign target young adults, warning them of the dangers of opioid addiction. The ad campaign includes four television and digital ads featuring true stories of young people who have struggled with addiction and took steps to injure themselves in order to get access to more opioids.

“Many Americans have developed their addiction following treatment for a painful condition, and many are overdosing on prescription painkillers or illegal opioids like heroin and illicit fentanyl. In fact, it is estimated that between 60% and 75% of Americans who use heroin started with misusing prescription opioids,” wrote Secretary Azar and Admiral Brett P. Giroir, MD, Assistant Secretary for Health, in a powerful public statement on the crisis released in June 2018 (1).

In addition to the public service campaign, one of the keys to success in reducing the fight against opioid-related deaths is ensuring patients and their families have access to safe alternatives to manage pain. ASN is working in partnership with other advocates in Washington—including the American Association of Kidney Patients (AAKP) and the Renal Physicians Association (RPA) to ensure alternatives exist for people affected by kidney diseases.

“But as we combat the opioid crisis, we cannot forget that pain is a real problem,” wrote Giroir and HHS Secretary Azar in their statement. “Severe pain—chronic or acute—affects a broad spectrum of our fellow Americans: our children, our parents, our spouses, our relatives, or our neighbors. We must do a better job of securing for them safe, effective options for managing pain.”

Pain and pallliative care

The increased national focus on the potential dangers of opioid products also comes at a time of increased national focus on the importance of palliative care throughout the course of patients’ lives—not just when the conservative care option is selected—and recognizing pain management as an important part of quality of life from the patient perspective.

For people with kidney diseases, however, finding the right pain management solution can be complicated by the importance of avoiding non-steroidal anti-inflammatory drugs (NSAIDS), which can harm the kidneys and hasten the progression to kidney failure. As our nation’s healthcare system aims to reduce misuse of opioids, safe alternatives such as over-the-counter medications like acetaminophen become important tools in the toolbox, especially for people for whom NSAIDS are unsafe.

“Concerningly, the Food and Drug Administration issued notice under the Obama administration that it planned to limit access to higher-strength acetaminophen, which can be obtained over the counter,” commented ASN President Mark D. Okusa, MD, FASN. “For people with kidney diseases, especially those who already face a high daily pill burden, limiting access to higher-dose acetaminophen products would present a challenge. They may either be forced to increase pill burden with multiple lower doses of the product, or consider more risky pain management strategies such as NSAIDS or even opioids.”

At a time when safer alternatives to opioids are needed, ASN and other members of the Patient Access to Pain Relief coalition are advocating to ensure that access to acetaminophen—which when used appropriately constitutes a safe pain management option—is preserved under the Trump administration.

In June 2018, HHS hosted the first meeting of the Pain Management Best Practices Inter-Agency Task Force, a critical component of the 2016 Comprehensive Addiction and Recovery Act. This important body is charged with reviewing current best practices, determining if there are any gaps in practice, and developing recommendations to improve pain management.

The Task Force includes representatives of HHS agencies, the VA, Department of Defense, and the Office of National Drug Control Policy, as well as non-federal representatives with diverse expertise in pain management, advocacy, addiction, recovery, substance use disorders, mental health, minority health, and more. Members also include patients, first responders, hospitals, and groups with expertise in overdose reversal.

In recent weeks, the society and other coalition members have met with both White House staff and top HHS aides, focusing on the need to educate about safe use of acetaminophen instead of restricting access to it altogether.

ASN will continue to work collaboratively to ensure people with kidney diseases and their care teams have access to a range of safe alternatives to opioids and NSAIDS.