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"We are looking to try to work with provider groups and work with the community as much as we can." The agency is currently working with provider groups to formulate guidelines that could be incorporated into drug labeling that could form the basis of how opioids get dispensed. Also, "national e-prescribing could help providers to exert more of their own oversight," Gottlieb said. The agency also is acting on several other fronts in the opioid crisis, he said. On Tuesday, the FDA issued a statement on kratom , a botanical substance Gottlieb described as "an opioid-like product [that] may be fueling the addiction epidemic." People have been using the drug to treat opioid withdrawal symptoms, and to get high, he noted. FDA sent the Drug Enforcement Administration (DEA) an "8-factor analysis" of kratom to help with the DEA's decision on how to "schedule" the drug. "We wanted to be very transparent around our concerns," he said. Loperamide (Imodium) is another drug people are taking in very high doses, both to reduce addiction symptoms and to get a different high, said Gottlieb. However, high doses of the drug can also cause toxicity. To prevent people from buying bottles containing high numbers of loperamide pills and blending them up into a "high-dose milkshake," the FDA announced in January that it is urging loperamide makers to change their packaging.

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