As U.S. opioid deaths mounted in 2016, the incoming head of the Food and Drug Administration promised a "sweeping review" of prescription painkillers in hopes of reversing the worst overdose epidemic in American history.
Dr. Robert Califf even personally commissioned a report from the nation's top medical advisers that recommended reforms, including potentially removing some drugs from the market. But six years later, opioids are claiming more lives than ever, and the FDA has not pulled a single drug from pharmacy shelves since the report's publication. In fact, the agency continues putting new painkillers on the market — six in the last five years.
Now Califf is back in charge at the FDA, and he faces skepticism from lawmakers, patient advocates and others about his long-promised reckoning for drugs such as OxyContin and Vicodin, which are largely blamed for sparking a two-decade rise in opioid deaths.
"All the concerns that we had at the time on opioids are still there. We still have a really huge problem," said Richard Bonnie, a University of Virginia public health expert who chaired the committee that wrote the report.
Bonnie and his co-authors say the FDA seems to have incorporated several of their recommendations into recent decisions, including a broader consideration of a drug's public health risks. But they say there is more to be done.
In an interview with The Associated Press, Califf said a new internal review of opioids has been underway for months and that the public will soon "be hearing a lot more about this." While the review will look at past FDA decisions, Califf suggested the focus will be on future policy.
"It seems like people love sort of looking back and fault-finding, but I'm much more interested in learning so we can go forward and make the best decisions for what we need to do today," said Califf, who split his time between Duke University and working for Google after leaving the FDA in 2017 following President Donald Trump's election.
The 453-page report issued five years ago this month by the National Academies of Sciences laid out a strategy for reducing overprescribing and misuse of opioids, with particular focus on the FDA.
At the center of the recommendations was a proposal for the FDA to reassess the dozens of opioids being sold to determine whether their overall benefits in treating pain outweigh their risks of addiction and overdose. Those that don't should be removed from the market, the group said.
The lack of swift action underscores the glacial pace of federal regulation and the legal obstacles to clawing back drugs previously deemed safe and effective.
"It's really hard for the agency to get a drug taken off the market once it's been approved," said Margaret Riley, a food and drug law professor who consulted on the report.
Last year, U.S. overdose deaths soared to a record of 107,000, driven overwhelmingly by fentanyl and other illegal opioids.
Opioid prescriptions have fallen about 40% in the last decade amid restrictions by hospitals, insurers and state officials. But deaths tied to the medications remain at 13,000 to 14,000 per year. And studies suggest people who become addicted to opioids continue to start with prescription opioids, before switching to cheaper heroin and illegally made fentanyl.
"If Dr. Califf is serious about addressing the drug epidemic, the FDA should immediately implement" the report's recommendations, Sen. Joe Manchin of West Virginia said in a statement.