The DEA says that one kilogram of fentanyl powder costs a few thousand dollars from a Chi- nese supplier, but can be manufactured into more than 650,000 pills, for millions of dollars in profit. Even worse is carfentanil, an elephant tranquil- izer, now showing up on the streets. A dose the size of a grain of sand is 100 times more powerful than fentanyl and 10,000 times more powerful than morphine. This drug is so lethal that veteri- narians wear protective gear when they handle the drug so that they don’t absorb the dose through their skin. Shockingly, carfentanil and fentanyl can be ordered openly online from China, in addition to being smuggled across the border. In 2015, U.S. Customs and Border Protection seized close to 300 pounds of synthetic opioids, compared to only eight pounds in 2014. Local, federal, and international agencies are increasing the crackdown on manufacturers and trafficking venues, despite the war on drug trafficking being far from over. Opioids could kill nearly half a million people over the next decade…as many Americans as HIV/AIDS has killed since that epidemic began in the early 1980s. —Max Blau, in STAT magazine A dding fuel to the fire is the controversy surrounding methods for treatment and stigmas surrounding users. First respon- ders and nonprofit addiction and recovery agen- cies have long been in the crossfire of controversy for solutions such as handing out clean needles to heroin users, or opening methadone clinics WWW.AGRM.ORG JANUARY/FEBRUARY 2018 11 Ī Consider ways to increase and maximize use of prescription drug monitoring programs, which are state-run databases that track prescriptions for controlled substances and can help improve opioid pain reliever prescribing, inform clinical practice, and protect patients at risk. Ī Consider policy options relating to pain clinics to reduce prescribing practices that are risky to patients. Ī Evaluate state data and programs and consider ways to assess Medicaid, workers’ compensation programs, and state-run health plans to detect and address inappropriate prescribing of opioid pain relievers, such as through use of prior authorization, drug utilization review, and patient review and restriction programs. Ī Increase access to substance abuse treatment services, including Medication- Assisted Treatment (MAT), for opioid addiction. Ī Identify opportunities to expand first-responder access to naloxone, a drug used to reverse overdose. Ī Promote and support the use of the CDC Guideline for Prescribing Opioids for Chronic Pain. Ī Help local jurisdictions to put these effective practices to work in communities where drug addiction is common. Promising Strategies The Centers for Disease Control and Prevention offers recommendations to states to combat the opioid crisis Continued on page 14 Ī