With about 146 Americans dying of opioid overdoses every day, the National Center on Addiction and Substance Abuse is encouraging states to take the lead on addressing the crisis, and to do so using a public health framework.
The national nonprofit research and policy organization issued a report Wednesday to state policymakers showing ways that states can, and do, attack the opioid epidemic. The organization, staffed by experts in fields includnig substance use and addiction, has been funded by grants from the National Institutes of Health, the national Substance Abuse and Mental Health Services Administration and private and corporate foundations.
Ending the Opioid Crisis: A Practical Guide for State Policymakers, provides examples of successful programs in states nationwide that are grappling with the opioid epidemic.
The center outlines four issues that states must address: Preventing misuse of the drugs, reducing overdose deaths, improving treatment and providing evidence-based care in the criminal justice system.
“You can’t just pick one,” said Lindsey Vuolo, associate director of health law and policy for the New York-based organization and the guide’s lead researcher.
Vuolo said one of the biggest obstacles to ending the epidemic is the bias that people have about addiction, and in particular, opioid addiction.
“Stigma remains the largest barrier to effectively addressing this epidemic,” she said. “Stigma is still pervasive.”
States need to use existing evidence that opioid addiction is a health issue, Vuolo said. And, using that information, they must provide evidence-based solutions to the problem.
That can mean supporting, or providing funding to, medication-assisted treatment programs in communities and in the criminal justice system. “It is the gold standard treatment for treating opioid addiction,” Vuolo said.
In the guide, the addiction center points to several evidence-based programs, including Rhode Island’s use of all FDA-approved medications for those with opioid addiction who are behind bars.
Cincinnati area jails have incorporated medication treatment in some of its jails, at least at the time of addicted inmates’ releases. But none provide all the medications available for opioid addiction.
The report also encourages state programs that promote the use of naloxone, the antidote to opioid overdose.
The center pointed to Ohio’s Project DAWN (Deaths Avoided With Naloxone) as a good program that gets naloxone to those who are at the greatest risk of overdose.
Although it did not make the guide, Hamilton County is beginning a naloxone program that will put thousands of the nasal-spray kits in locations that aren’t currently stocked with the medication.
Vuolo said those who oppose the use of naloxone may not understand it.
It does not encourage heroin use or opioid misuse, she said. The reason people continue to use these drugs after they’re revived is due to changes in the brain that compel them to do so. Avoiding death isn’t a motivator to staying drug-free, Vuolo said. “Death is not a deterrent to people who are addicted.”
What needs to happen post-naloxone revival is treatment, however, Vuolo said. The report applauds several treatment programs across the nation that try to catch users who seek help.
One is a “hub-and-spoke” program in Vermont. The state’s Care Alliance for Opioid Addiction expanded access to medication-assisted treatment with hubs that treat the addicted and provide their counseling and “spokes” reaching out to physicians in the community who can continue treatment after a person is stabilized. Doctors who have other practices can help with addiction treatment but not become overwhelmed.
To help prevent substance misuse, the center points to addiction education and awareness programs, including campaigns that focus on parents – the first line of defense for keeping children safe from substance misuse.
To stop the spread of infectious diseases, the guide recommends starting needle exchange programs. That’s because infections including the hepatitis viruses and HIV can be passed on by sharing needles or getting stuck with a discarded needle.
The report also notes that states should remain vigilant in watching doctors’ prescribing of opioids.
The guide gives a shout-out to Kentucky for its early mandatory use of a prescription data monitoring program, which tracks patients’ prescriptions and who wrote them, helping to end doctor shopping and decrease unnecessary prescribing.
Researchers acknowledged there is a cost that states and communities must bear in getting the opioid crisis under control. It recommends that local governments offset some of those costs with federal funds that have been made available through the Comprehensive Addiction and Recovery and the 21st Century Cures acts.
But Vuolo noted that recognizing addiction as a health condition should also motivate state leaders to provide funding to fix it.
“If there were this many Americans dying per day from any other cause, would we even be considering the cost of the solution?” she asked.
No place is safe from this evil attack.