More than 140 Americans die daily from an opioid overdose. President Trump declared the opioid crisis a public health emergency. However, a public health emergency is not the same as a national emergency. A public health emergency, unlike a national emergency, does not free up additional funding. Instead it relies on existing funding to be redirected. The nation’s Public Health Emergency Fund has a current balance of just $57,000. But the opioid crisis is a $6 billion problem, at minimum! Although it can be renewed, the declaration only lasts for 90 days. It is said the Trump administration is working with Congress to include further funding for the crisis soon.
Opioid dependence is a complex problem that requires a multifaceted response. It is a different animal from other addictions in that it is a physiological and psychological disease. Whereas other substances are primarily psychological. People who don’t understand this difference may think that all it takes to recover is to “Just Say No”. Kellyanne Conway suggested that the best way to stop drug dependency and the epidemic overdose deaths plaguing the US is for people to not start using drugs. True enough, but DARE and “Just Say No” have proven to be ineffective. And that doesn’t account for the people who inadvertently became dependent on painkillers through a medical condition.
I spoke with a group of people in an opiate recovery support group as they discussed how they would approach the crisis. They hope that bringing awareness to the epidemic is not an empty gesture, but will in fact allocate time, energy and funding to make a difference. They offered the following concrete ideas for treatment and prevention in order to curb the crisis.
- Make Naloxone, a.k.a. Narcan, accessible and affordable. Naloxone is the opiate reversal kit to stop overdose deaths.
- Make treatment more accessible than pills, heroin or fentanyl. Open more medication assisted treatment programs that offer Methadone and Suboxone such as “mobile Methadone” programs to serve rural areas. Make medication as easily available as your local pharmacy.
- Mandatory insurance coverage for addiction treatment.
- Prevention that is age appropriate, starts in 4th grade, and progresses to include the science of brain chemistry in high school. Don’t replicate programs that are not evidenced based.
- Provide transportation to treatment. Encourage public or private transportation companies to open services to help addicts get to treatment.
- Offer mental health counseling to alleviate mental illness and learn coping skills.
- Make use of harm reduction programs such as a needle exchange program, condoms, and safe houses.
- Make medication assisted treatment available at all levels of care from outpatient to residential programs. Too many hospital based and residential programs refuse to treat people who are prescribed Methadone or Suboxone, and instead require them to stop their medication before receiving care.
- Prioritize care to special populations and high risk groups such as the homeless, pregnant women, and veterans.
- Offer wrap around services that include addiction treatment, job placement, mental health services, housing, and legal assistance.
- Destigmatize the use of medication for opioid dependent people through public education.
- Increase family treatment designed to keep families intact and increase social support.
- Create work programs to help people pay for their treatment and gain work skills.
- Require all correctional staff to get training in medication assisted treatment and allow inmates to take their medication during incarceration. If they are not maintained on a medication during jail time, they should be offered it prior to their release, and at a minimum should be given Naloxone upon their discharge.
- Decriminalization of drugs.
- Physician / substance abuse counselor teams to treat this population. Physicians are not the most effective first line responders. Require physicians to have ongoing addiction education.
- Increase the use of Prescription Monitoring Logs to identify people in need and make appropriate referrals.
- Emergency hospital services for people in withdrawal. Provide hydration and comfort, do assessments and make recommendations. If desired, begin a medication, and link to substance abuse providers for continuing care.
How would you direct funds to alleviate this epidemic? Your thoughts and efforts toward a comprehensive public policies could save a life.
It is my firm belief that public policy should be guided through the use of focus groups that consist of opioid dependent people. Wisdom comes from the lived experience of the people that suffer this disease. Many thanks to the individuals who shared their expertise.