Michigan Association of Health Plans

Coming Together to Solve the Opioid Crisis

Originally published by U.S. News 

SOCIAL, EDUCATIONAL AND medical barriers need to be lowered in order to address the multiple facets of the opioid epidemic, leaders from multiple industries said during the closing keynote discussion of the 2018 Healthcare of Tomorrow conference.

“You don’t resolve what you don’t understand. Let’s get the data, let’s analyze, let’s understand what the current state of the epidemic is,” Dr. Marcelo Bigal, chief medical officer for Purdue Pharma, told the crowd in the nation’s capital on Friday. “Let’s get to the facts and align in a way that serves the public.”

Bigal joined Dr. Joseph Hsu, vice chair for quality of Atrium Health’s Musculoskeletal Institute; Dr. Laura Kehoe, medical director of Massachusetts General Hospital’s substance use disorder bridge clinic; and John “Jack” Donahue, chief of strategic initiatives for New York City’s police department to discuss the opioid epidemic. Brian Kelly, editor and chief content officer at U.S. News, moderated the discussion.

On average, 115 Americans die each day from an opioid overdose, according to the Centers for Disease Control and Prevention. In New York City, Donahue said, they have seen five times as many deaths from opioid overdoses as lives lost to murder. He said the crisis has inspired his police department to change its view of the epidemic from a crackdown on drug use to a public safety concern.

“It’s still lives that are being lost and lives that are being destroyed, and it’s not just those who have become addicted, it’s those families,” Donahue said. “The idea is to prevent crime and save lives.”

Working to increase conversations between public safety professionals like Donahue and public health professionals can help to get more people into treatment, Kehoe said. Further, providing immediate individualized care and continuing to keep patients engaged in their addiction treatment – even if they relapse – is key to keeping them in recovery.

“There’s this misconception amongst many of us that if people are ready and willing (to seek treatment) … they have to be ready and willing to totally stop, and we do this with no other illness in medicine,” Kehoe said. “When you think about people with addiction, they have to often change their support groups. If they are living on the streets, there’s often a lot of open air drug use around them that abounds. Many people stay with people where there is drug use; they may have criminal justice involvement – multiple triggers.”

“So, the goal is to lower those barriers to care, to engage them and get them treated,” she said. “This illness has a higher remission rate than diabetes, than hypertension, than other chronic illnesses if they get the right treatment.”

On the prevention side, Hsu of Atrium Health says one of the biggest challenges is having appropriate alternative pain management options, such as physical therapy or chirotherapy, accessible to patients – and covered by insurance.

“We’re the only country in the world where the primary treatment for a nonoperative, minor fracture is an opiate therapy,” Hsu said. “We need to be very intentional about some of these other non-pharmaceutical strategies for comfort and alleviation of pain.”

But for chronic pain patients who are already dependent on prescription drugs, Hsu says, prescription limits and cutbacks by physicians are creating another systemic problem.

“As states have regulated opiate use, clinicians are afraid to even prescribe opiates … primary care physicians are no longer treating chronic pain, and so we’re creating opiate orphans,” Hsu said. If they don’t have access to care, he added, “then those are people that unfortunately will transition to injection drug use.”

Bigal agrees.

“Pain matters, addiction matters, and I believe that if we don’t understand this crisis with the complexity it needs, we’re going to keep perpetuating a problem that needs to stop,” he says.

Despite all the barriers that remain, the panelists said they are positive that the country is on the right path to solving the opioid problem.

“We have to be optimistic,” said Donahue of the New York City Police. “We have to be because we know we can change our communities.”

“We have the data we need, we have the urgency and we have the attention,” Bigal said. “I think we are where we should be, and I am optimistic that we actually can do something pending our willingness to go deep.”

Read the full story at U.S. News