Searching for solutions to the opioid crisis

BALTIMORE—Healthcare executives and public health officials pushed for easier access to drugs that reduce dependency on painkillers, as well as for a less punitive approach to dealing with those addicted to opioids, in sessions at a conference on April 25-26.

Modern Healthcare hosted a gathering of more than 150 in a city that has implemented some of the more progressive strategies, including a blanket prescription for the overdose-reversal drug naloxone.

The opioid epidemic claimed more than 64,000 lives last year; more than 42,000 of those deaths involved prescription drugs.

Baltimore Mayor Catherine Pugh urged hospitals to look at addiction as an illness. Just a few days after the symposium, she announced an initiative aimed at identifying best practices for the city's 11 hospitals to follow when responding to the opioid crisis. Among the practices are: providing treatment to patients who screen positive for addiction; distributing naloxone to patients; connecting patients with peers or other support services; and ensuring physicians prescribe opioids judiciously.

"This is a national health crisis and it needs to be treated with the advanced medical resources that we know can be effective and which for sure will save lives."

Baltimore Health Commissioner Dr. Leana Wen said treating addiction as a crime is inhumane and stressed the importance of having resources available to immediately engage patients with addiction issues. She recalled learning that one of her patients visited the emergency department 172 times before dying of an overdose. She also spoke regretfully of over-prescribing opioids herself as a result of a medical culture influenced by painkillers marketed as safe and a requirement to use the pain scale. She urged the medical community to consider opioid addiction's social roots such as unemployment.

"Imagine saying to a patient having a heart attack, we can't treat you now?"

Former White House drug czar Michael Botticelli, who is currently executive director of the Grayken Center for Addiction at Boston Medical Center, called for an annual funding commitment for treatment and prevention that matches the levels of those appropriated for the Ryan White HIV/AIDS program, which has received more than $2 billion a year over the past decade.

Brandeis University Professor Dr. Andrew Kolodny said efforts to limit opioid prescribing in recent years have been positive steps but warns that there are about 10 million to 12 million patients in the U.S. who have been on painkillers for years and need alternative therapies to offset the potential damage that could be caused by being cut off cold turkey.

"We're not in a position with opioids where we can stop on a dime—that's the challenge."

Dr. Joshua Sharfstein, vice dean for public health practice and community engagement at Johns Hopkins Bloomberg School of Public Health, said too many U.S. treatment facilities still equate substance use disorder with some type of moral failing. He believes that's led to a dearth of rehabilitation providers offering medication-assisted treatment and an abundance of abstinence therapies, which are tied to higher rates of relapse and death.