Meanwhile, peer-reviewed studies were contradicting the safety and efficacy claims. Researchers found that, although opioids could be used to treat short periods of acute pain, pain patients on opioids did not do well over the long term.

In early 2014, actor Philip Seymour Hoffman died from an opioid overdose at age 46, spurring a public reckoning with the drugs’ prevalence. Even then, however, the federal government response was muted.

Kolodny compares President Barack Obama’s neglect of the opioid issue to Ronald Reagan’s lack of action on the AIDS crisis in the 1980s. “I don’t think the opioid crisis was on Obama’s radar,” Kolodny says. “He started to do the right things at the very end but never spoke about the problem publicly until his last year in office.”

Gradually, Kolodny shifted his focus from raising awareness of the crisis to researching how to fight it. “To bring the epidemic to an end, we have to prevent more people from getting addicted,” he says. “And, more than anything, that means cautious prescribing.”

In 2015, Kolodny used a grant and support from IBH to look at the prescription patterns of doctors in New York state, studying data from the state’s Prescription Drug Monitoring Program (PDMP), which tracks all opioid prescriptions.

Years earlier, Kreiner had established the Prescription Drug Monitoring Program Training and Technical Assistance Center to help improve state PDMPs through a combination of academic research and on-the-ground consultation with former PDMP administrators. In 2011, the CDC approached him about combining prescription data from multiple states.

The CDC was “a little blindsided by the intensity of the opioid problem,” Kreiner says. “A big part of that was the lack of timeliness of getting good data.”

Currently, Kreiner’s database contains data from 12 states. He’s used the information to develop a set of 43 measures of risky patient and prescriber behavior that could increase the risk of addiction.

As of now, 50 different state laboratories struggle with how to monitor and control opioid prescriptions. Some states have passed laws requiring doctors to check PDMP databases before writing a new prescription. Others have limited the number of days before a patient can get a refill. “People are trying things without really knowing what’s going to work,” Kolodny says.

“We have found no effect for even the most comprehensive laws on daily opioid dosage,” says Kreiner.

Perhaps that’s because states that limit the number of days before refills don’t specify limits on the dose, allowing patients to still get dangerous amounts. By drilling down deeper on the relevant data, the Prescription Drug Monitoring Program Training and Technical Assistance Center may be able to help states create more-effective laws.

‘It really is Kryptonite’

At the same time, states are investing in treatment for those already suffering from opioid addiction. “The genie is out of the bottle,” says Kolodny. “Doctors’ starting to prescribe cautiously doesn’t mean patients’ addictions are going to go away. It means building out a treatment system that doesn’t exist yet.”

Even before prescriptions began declining in 2011, young people were turning to the black market to buy heroin, often a cheaper alternative to OxyContin. In recent years, opioid overdose deaths among heroin users have risen rapidly. The heroin supply, which often has fentanyl mixed into it, has become more dangerous.

Although evidence shows the best treatment combines counseling with drugs like buprenorphine or methadone, abstinence-only programs predominate at treatment centers. “It’s easier for people who are addicted to buy heroin than it is to find a doctor who will treat their opioid addiction with buprenorphine,” Kolodny says.

The result is stories like Kevin Flattery’s. A member of an affluent Northern Virginia family, Flattery attended a Jesuit prep school, played varsity ice hockey and graduated from the University of Virginia ready to pursue a career as a screenwriter. Once in Hollywood, however, he began experiencing anxiety and depression. Remembering a long-ago treatment with opiates for a sports injury, he started self-medicating with OxyContin. “Like a lot of people, he seriously underestimated its addictive qualities,” his father, Don, says. “It really is Kryptonite.”

After Kevin became addicted, he sought help from his family, returning on a plane from LA in full withdrawal, suffering from fever sweats and looking like he hadn’t slept or eaten in days. His family was able to get him stabilized with buprenorphine and found a residential drug-treatment program to help him detox. The program advocated complete abstinence, releasing him clean after 30 days. Within another 30 days, he had relapsed and fatally overdosed. He was 26.

“We had to learn the hard way that opioid addiction is a chronic disease that affects brain circuitry and chemistry, and it takes a long time to rewire,” says Don Flattery, who is now, along with Kolodny, a committee member in FED UP!, an advocacy group pushing for an increased federal response to the opioid crisis.

Flattery credits Kolodny with helping survivors deal with the devastating effects of their loss. “He has been an absolute champion for American families in continuing to fight against very powerful interests,” Flattery says.

Others at Brandeis are also leaders in the fight. For the past 15 years, Connie Horgan and senior scientist Sharon Reif have examined medical coverage for treatments as part of a larger study on drug, alcohol and mental-health services. They have found that many health plans either neglect to include addiction-treatment drugs on their formularies or place them on the highest-cost tier. “If a medication isn’t on the formulary or you are going to have to pay out of pocket for it, you are not going to get access to it,” says Horgan.

Health insurers often have an attitude that “use of medication means you are not recovered from your addiction — or that it is just a substitute for heroin — which is far, far from the truth,” adds Mady Chalk, Heller PhD’80, an expert on the opioid crisis.

As awareness of the crisis has increased, a growing number of states are enacting policies to treat opioid addiction. “The more states look at their own data to make decisions, the better we’ll be able to address the opioid epidemic,” Chalk says.

Despite the increasing awareness, Kolodny still gets criticism — sometimes from patients who take opioids and fear losing access to their medicine. A group of patients and a few doctors who lost their medical licenses for overprescribing opioids recently signed a letter addressed to President Liebowitz demanding Kolodny be fired. The university has no intention of firing Kolodny, says Horgan, who notes that IBH gets many letters that praise his work.

For his part, Kolodny expresses compassion for his critics. “I think of them as victims of our era of aggressive prescribing,” he says. “Many will have a hard time ever coming off opioids.” Nevertheless, “we need to prevent more pain patients from winding up in their shoes. Compassionate care for patients with pain isn’t jeopardized by more-cautious prescribing — it demands it.”

Though the tide of awareness has started to turn, the U.S. has a long way to go to solve the opioid-addiction epidemic. Unlike Obama, President Donald Trump hasn’t ignored the problem — in fact, he’s often spoken out publicly about the need to address it. When it comes to Trump’s record of action, however, Kolodny sums up his reaction in one word: “disappointed.”

The Trump administration’s declaration last fall that the opioid crisis is a public-health emergency is wholly inadequate, Kolodny says, since it came without any dedicated funds to fight the problem. Trump’s commission on the crisis issued its final report in November, punting the issue back to the states, with a call for Congress to issue an indeterminate amount of money in block grants.

“Trump certainly gets a better grade than Obama on speaking about the problem,” Kolodny says. “But there hasn’t been any action — none, zilch — from the administration. We don’t need another commission that issues recommendations. We need a plan, and we need funding that addresses the crisis.”

If one reads into what this article states… it is not clear if Brandeis is benefiting from what Kolodny is doing or Kolodny is riding on Brandeis’ coattails.  The fact that Kolodny is employed by Heller School’s Institute for Behavioral Health (IBH) at Brandeis University… would suggest that everyone involved with this project suggest that they knew that they were dealing with a mental health issue (addictive personality), but proceeded to proceed blaming various opiates. 

So Kolodny and Brandeis is “marketing” a medication for addiction that is a C-III and until 2014 Hydrocodone/Acetaminophen was a C-III. If one reads the DEA definition of what a C-II med is and what a C-III med is … they don’t vary all that much.  Substituting the dependency on one medication to another medication…can that really be labeled as a means to stop opiate abuse ?

Our Congress in 1999 declared that 2000-2009 was the “decade of pain” and the Joint Commission jumped on that law with “both feet” and declared that pain was a 5th vital sign and made pain management – especially in the hospitals that they accredited – a MAJOR STANDARD.  If a hospital failed meeting a major standard the hospital runs the risk of losing their ability to bill for services provided to Medicare & Medicaid pts.

While Purdue’s printed literature stated that Oxycontin was “less addicting” when prescribed to chronic pain pts and many studies validate that 98%+ of chronic pain pts prescribed routine dosing of any opiates WILL NOT BECOME ADDICTED.  Between Purdue’s marketing and the “decade of pain”.. may have contributed to some careless prescribing of opiates.

If one notices, there seems to be no mention that all of these people who were labeled as “addicts” weren’t already abusing/addicted to the two drugs -Nicotine and Alcohol – since we have some 30-40 million people abusing/addicted to both of these legal drugs.. why is there not some other stats on these opiate addicts/substance abusers on what other mental health addictive personality they may be involved in.

Has Kolodny and IBH had an intentional myopic viewpoint of the entire scope of the various substances that these people are using/abusing ?