Government Legislation in Response to the Opioid Epidemic

  • Mark R. JonesEmail author
  • Matthew B. Novitch
  • Syena Sarrafpour
  • Ken P. Ehrhardt
  • Benjamin B. Scott
  • Vwaire Orhurhu
  • Omar Viswanath
  • Alan D. Kaye
  • Jatinder Gill
  • Thomas T. Simopoulos
Hot Topics in Pain and Headache (N Rosen, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hot Topics in Pain and Headache


Purpose of Review

Opioid misuse and abuse in the USA has evolved into an epidemic of tragic pain and suffering, resulting in the estimated death of over 64,000 people in 2016. Governmental regulation has escalated alongside growing awareness of the epidemic’s severity, both on the state and federal levels.

Recent Findings

This article reviews the timeline of government interventions from the late 1990s to today, including the declaration of the opioid crisis as a national public health emergency and the resultant changes in funding and policy across myriad agencies. Aspects of the cultural climate that fuel the epidemic, and foundational change that may promote sustained success against it, are detailed within as well.


As a consequence of misuse and abuse of opioids, governmental regulation has attempted to safeguard society, and clinicians should appreciate changes and expectations of prescribers.


Opioid epidemic Addiction Overdose Prescription drug monitoring program Commission on combating drug addiction Opioid crisis Abuse-deterrent formulations 


Compliance with Ethics Standard

Conflict of Interest

Mark R. Jones, Matthew B. Novitch, Syena Sarrafpour, Ken P. Ehrhardt, Benjamin B. Scott, Vwaire Orhurhu, Omar Viswanath, Alan D. Kaye, Jatinder Gill, and Thomas T. Simopoulos declare no conflict of interest. Dr. Kaye is a speaker for Depomed, Inc. and Merck, Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as:•• Of major importance

  1. 1.
    Promotion and Marketing of OxyContin. Commercial triumph, public health tragedy. Am J Public Health. 2009;99(2):221–7.CrossRefGoogle Scholar
  2. 2.
    •• Jones MR, Viswanath O, Peck J, Kaye AD, Gill JS, Simopoulos TT. A brief history of the opioid epidemic and strategies for pain medicine. Pain Ther. 2018;7(1):13–21. Provides an overview of the evolution of opioid use into the epidemic of today. CrossRefGoogle Scholar
  3. 3.
    •• Dart RC, Surratt HL, Cicero TJ, Parrino MW, Severtson SG, Bucher-Bartelson B, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(3):241–8. Traces the development of opioid use into the current proportions. CrossRefGoogle Scholar
  4. 4.
    National Vital Statistics System. Multiple cause of death file. Atlanta: Centers for Disease Control and Prevention; 2012.Google Scholar
  5. 5.
    •• Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4):569–576. Discusses the causes and prevalence of opioid use disorder in patients suffering from chronic pain. CrossRefGoogle Scholar
  6. 6.
    •• MR J, Kaye AD, Kaye AJ, Urman RD. The emerging therapeutic roles of κ-opioid agonists. J Opioid Manag. 2016;12(2):101–7. A useful insight into recent research concerning opioid medications. CrossRefGoogle Scholar
  7. 7.
    •• Volkow ND, McLellan AT. Opioid abuse in chronic pain--misconceptions and mitigation strategies. N Engl J Med. 2016;374(13):1253–63. Discusses the pertinent characteristics and patterns of patients with chronic pain and proposes strategies for interventions. CrossRefGoogle Scholar
  8. 8.
    Ewan EE, Martin TJ. Analgesics as reinforcers with chronic pain: evidence from operant studies. Neurosci Lett. 2013;557:60–4.CrossRefGoogle Scholar
  9. 9.
    Williams JT, Christie MJ, Manzoni O. Cellular and synaptic adaptations mediating opioid dependence. Physiol Rev. 2001;81:299–343.CrossRefGoogle Scholar
  10. 10.
    Buntin-Mushock C, Phillip L, Moriyama K, Palmer PP. Age-dependent opioid escalation in chronic pain patients. Anesth Analg. 2005;100:1740–5.CrossRefGoogle Scholar
  11. 11.
    Volkow ND, Morales M. The brain on drugs: from reward to addiction. Cell. 2015;162:712–25.CrossRefGoogle Scholar
  12. 12.
    Center for Substance Abuse Treatment. Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2004.Google Scholar
  13. 13.
    Schaeffer T. Abuse-deterrent formulations, an evolving technology against the abuse and misuse of opioid analgesics. J Med Toxicol. 2012;8(4):400–7.CrossRefGoogle Scholar
  14. 14.
    H.R. 6344 – 109 Congress: Office of National Drug Control Policy Act of 2006.Google Scholar
  15. 15.
    Byrne, Katie, editor. Comprehensive accreditation manual: CAMH for hospitals effective January 1, 2018. Joint Commission, 2018.Google Scholar
  16. 16.
    Opioid Overdose: State information. Center for disease control and prevention, 23 Oct. 2017,
  17. 17.
    Prescription drug monitoring programs (PDMPs). Federation of State Medical Boards. April 2018.
  18. 18.
    Finley EP, Garcia A, Rosen K, McGeary D, Pugh MJ, Potter JS. Evaluating the impact of prescription drug monitoring program implementation: a scoping review. BMC Health Serv Res. 2017;17:420.CrossRefGoogle Scholar
  19. 19.
    Rutkow L, Vernick JS. Emergency legal authority and the opioid crisis. N Engl J Med. 2017 Dec 28;377(26):2512–4. Scholar
  20. 20.
    Rutkow L, Vernick JS, Alexander GC. More states should regulate pain management clinics to promote public health. Am J Public Health. 2017;107:240–3.CrossRefGoogle Scholar
  21. 21.
    Rutkow L, Chang H, Daubresse M, Webster D, Stuart EA, Alexander GC. Effect of Florida’s prescription drug monitoring program and pill mill laws on opioid prescribing and use. JAMA Intern Med. 2015;175(10):1642–9.CrossRefGoogle Scholar
  22. 22.
    Centers for Disease Control and Prevention (CDC). Drug overdose deaths: Florida, 2003-2009. MMWR Morb Mortal Wkly Rep. 2011;60(26):869–72.Google Scholar
  23. 23.
    “Emergency declarations in eight states to address the opioid epidemic.” Association of state and territorial health officials, 11 Jan. 2018,
  24. 24.
    “Emergency department data show rapid increases in opioid overdoses.” Centers for Disease Control and Prevention (CDC). March 6, 2018.
  25. 25.
    “State grant programs.” Substance abuse and mental health services administrations, 30 Jan. 2018,
  26. 26.
    “Strategic prevention framework for prescription drugs.” Substance abuse and mental health services administrations, 03/29/2016,
  27. 27.
    Christie, C., Baker, C., Cooper, R., Kennedy, P., Madras, B., & Bondi, P. (2017). On combating drug addiction and the opioid crisis.Google Scholar
  28. 28.
    Dasgupta N, Beletsky L, Ciccarone D. Opioid crisis: no easy fix to its social and economic determinants. Am J Public Health. 2018 Feb;108(2):182–6. Scholar
  29. 29.
    Dowell D, Zhang K, Noonan RK, Hockenberry JM. Mandatory provider review and pain clinic laws reduce the amounts of opioids prescribed and overdose death rates. Health Affairs (Project Hope). 2016;35(10):1876–83. Scholar
  30. 30.
    Kanouse AB, Compton P. The epidemic of prescription opioid abuse, the subsequent rising prevalence of heroin use, and the federal response. J Pain Palliat Care Pharmacother. 2015;29(2):102–14. Scholar
  31. 31.
    Kinnard EN, Philbin MM, Beletsky L. Government actions to curb the opioid epidemic. JAMA. 2018 Apr 17;319(15):1619–20. Scholar
  32. 32.
    Kolodny A, Frieden TR. Ten steps the federal government should take now to reverse the opioid addiction epidemic. J Am Med Assoc. 2017;318(16):1537–8. Scholar
  33. 33.
    Soelberg CD, Brown RE, Du Vivier D, Meyer JE, Ramachandran BK. The US opioid crisis: current federal and state legal issues. Anesth Analg. 2017;125(5):1675–81. Scholar
  34. 34.
    Stayner RS, Copenhaver DJ. Opioids, pain management and the law. Curr Opin Anaesthesiol. 2012;25(5):566–71. Scholar
  35. 35.
    HHS awards over $1 billion to combat the opioid crisis | [Internet]. [cited 2018 Sep 24]. Available from:
  36. 36.
    Keyes KM, Cerda M, Brady JE, Havens JR, Galea S. Understanding the rural-urban differences in nonmedical prescription opioid use and abuse in the United States. Am J Public Health. 2014;104:e52–9. Scholar
  37. 37.
    Ensuring patient access and effective drug enforcement act of 2016. Pub L No. 114-145, 130 Stat 353.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Mark R. Jones
    • 1
    Email author
  • Matthew B. Novitch
    • 2
  • Syena Sarrafpour
    • 1
  • Ken P. Ehrhardt
    • 3
  • Benjamin B. Scott
    • 4
  • Vwaire Orhurhu
    • 1
  • Omar Viswanath
    • 5
    • 6
  • Alan D. Kaye
    • 3
  • Jatinder Gill
    • 1
  • Thomas T. Simopoulos
    • 1
  1. 1.Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  2. 2.Medical College of WisconsinWausauUSA
  3. 3.Department of AnesthesiologyLouisiana State University Health Science CenterNew OrleansUSA
  4. 4.Department of Surgery, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  5. 5.Valley Anesthesiology and Pain ConsultantsUniversity of Arizona College of Medicine-PhoenixPhoenixUSA
  6. 6.Creighton University School of MedicineOmahaUSA

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