It feels like not a day goes by where the sheer scale of the opioid epidemic is not felt. The epidemic impacts nearly every American through our families, friends, loved ones, co-workers and classmates. According to the Centers for Disease Control (CDC), in 2017:
- On average, 130 Americans died each day from an opioid overdose.
- About 68% (47,600) of the more than 70,200 drug overdose deaths involved opioids.
- The number of overdose deaths involving opioids was 6 times greater than in 1999.
That same year, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that 1.7 million people living in the United States suffered from substance use disorders related to prescription opioid pain killers, and 652,000 suffered from a heroin use disorder (these statistics are not mutually exclusive). The CDC also estimates that the prescription opioid misuse alone in the United States costs $78.5 billion a year (this figure includes the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement).
The causes of the opioid epidemic are complex because so many socioeconomic forces came together to fuel the crisis. Marketing by drug companies incentivized using prescription opioids to medicate pain, health insurance companies refused to cover alternative treatments for managing chronic pain, and cut-rate heroin from Mexico and deadly Fentanyl were made easily available on the street for people already addicted and cutoff from prescription pain relievers.
At the same time, individuals living in vulnerable communities were squeezed out of affordable housing options and let go from stable employment opportunities. On an individual level, biological factors, community and family relations, the exposure to trauma and abuse, can all influence the prevalence of substance use and addiction.
Addiction is a disease that alters brain chemistry and therefore must be treated as a chronic illness. A crisis of this magnitude requires a collective response that treats the whole person in their environment. It needs to be triaged under the rubric of a public health approach that is understanding of the role of recovery in people’s lives.
“Treating the whole person is critical to successful recovery,” says Barbara Johnston, Director of Policy & Advocacy at the Mental Health Association of New Jersey (MHANJ), who spoke about their involvement in a state and national advocacy partnership with the National Council on Alcoholism and Drug Dependence (NCADD), “across the state, MHANJ and NCADD are working together on grassroots advocacy initiatives to raise awareness on co-occurring conditions.”
Facing this problem from all angles, community leaders are working side by side and with wide network of partners, including advocacy groups, primary care, behavioral health and human service providers, etc., to solve social determinants of health (SDOH) like housing, justice-involved, education, workforce, transportation and food insecurity, and influence public policy.
In 2016, New York State formed the Heroin and Opioid Task Force, comprising of healthcare providers, policy advocates, educators, parents and New Yorkers in recovery. Members of the task force hosted public hearings across the state to better inform their recommendations. Just recently, Governor Andrew Cuomo highlighted the task force’s actions as he announced that for the first time in a decade, the number of opioid deaths declined in New York State.
According to Governor Cuomo’s recent press release (https://www.governor.ny.gov/news/governor-cuomo-announces-first-reduction-opioid-overdose-deaths-new-york-state-2009?utm_source=December+13%2C+2019+Newsletter&utm_campaign=December+13%2C+2019&utm_medium=email), since 2016, the state opened nearly 500 new treatment beds, added more than 1,800 opioid treatment program (OTP) slots and made further strives with integrating Medication Assisted Treatment (MAT) services into primary care programs (resulting in nearly 47% increase in patients receiving buprenorphine prescriptions). In addition, New York also expanded the use of recovery centers, youth clubhouses, expanded peer services, Centers of Treatment Innovation, mobile treatment, telehealth and 24/7 open access centers. Yet, in marking these milestones and multipronged approach, Governor Cuomo noted that still 1,824 opioid deaths occurred in 2018 (a drop of 15.9% over 2017). There is still much more to accomplish.
In the state of New Jersey, the MATrx Model Concept emerged from the convening of family care physicians, community SUD providers, university-based providers, Federally Qualified Health Centers (FQHCs), ambulatory care clinics, pain and addiction specialists, as well as government subject matter experts. MATrx kicked off earlier this year and offers navigator services across three provider types:
- Office Based Addiction Treatment (OBAT) providers, which consist of primary care providers including Physician Assistants and Advance Practice Nurses;
- Premier Providers, like FQHCs, Certified Community Behavioral Health Centers (CCBHCs), Ambulatory Care Providers and Outpatient Treatment Providers); and
- Centers of Excellence, which are providers contracted by the state to provide training, consultation and peer services, in addition to primary care treatment for complex cases.
As of the fall, 400 providers received MAT and OBAT training and over 1,000 people were served since the launch of MATrx. However, partnering to solve the problems related to the opioid epidemic is not without complications. Stakeholders can hold different opinions on harm reduction versus treatment. Prior authorizations for MAT were eliminated, but formulary preferences and safety edits were left in place. Furthermore, inadequate reimbursement for MAT makes it difficult for providers to hire prescribers and integrate it into their existing services. Additionally, regulatory barriers impede the one stop community-based model where one could theoretically go to take care of all their primary care and behavioral health needs.
Solving the Problem
Government can support multidisciplinary partnerships and create new opportunities for community collaborations to form. In addition, states can implement prescription drug monitoring programs to reign in haphazard prescribing. They can also promote the use of CDC guidelines (https://www.cdc.gov/drugoverdose/prescribing/guideline.html) on prescribing opioids for chronic pain. Payers can collaborate with provider networks to improve recovery outcomes, expand evidence-based treatments, improve performance, ease care transitions and support access and adherence to MAT. The shift to value-based care holds potential for tying reimbursement to outcomes, If VBP can make community services fiscally viable, then providers could focus their efforts on recovery and high-quality care for people addicted to opioids.
Working together to solve the opioid epidemic with population health strategies that cut across prevention, intervention, treatment, recovery and enforcement, creates opportunities for pioneering partnerships to form and care collaboratives to become innovation engines. Engaging with internal leadership, we help organizations implement policies that support greater care integration, data-driven approaches and promising practices that are most meaningful for opioid use disorder providers. Through collaborations with statewide partners and payers, and advocating for the resources needed by providers, we can raise awareness and find new solutions to the problems associated with the opioid epidemic that we must confront together.