Congress, take an Ebola inspired approach to the opioid epidemic

Another twenty young adults are reported to have died over the weekend. Newspapers and cable talk shows report almost daily on the epidemic. As with previous epidemics, such as the Influenza epidemic of 1918, the death rate is highest amongst young adults. The disease afflicts all ethnicities and socioeconomic groups. In 2015 it killed 33,000 Americans — more than car accidents or guns. Every day 91 Americans die as a result of this epidemic, compared to 11,000 deaths worldwide from Ebola from 2013 to 2016. Is this a new virus that has spread more widely than SARS or MERVS? Is this a new superbug that is resistant to all antibiotics?

No, this is the epidemic of drug overdoses fueled by an ongoing opioid epidemic. There are few families in the US that have not been affected.

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Despite the horrific toll of misery and death, there is no significant national mobilization as we saw after a single Ebola death in the U.S. several years ago. Out of justified concern, local and state governments have attempted to apply legislative solutions to the problem. Some, such as the ISTOP program in New York, have been successful in reducing the number of drug-seeking “doctor shoppers.”

 

Similarly, restrictions on pill quantities have been placed into law. Meanwhile, health systems, hospitals and providers scramble to develop their own solutions, usually with no financial relief to their budgets.

The Trump administration has formed a task force led by New Jersey Gov. Chris Christie. Although this brings national prominence to the problem, task forces make recommendations but don’t have the authority to implement. Only a public-private partnership — government and the healthcare industry — will be able to operationalize a national strategy.

The problem requires a multidimensional solution. The four foundational pillars to help slow and stop this epidemic include limiting the supply of opioids, raising awareness of addiction risk, identification and management of dependence, and treatment of opioid addiction. The components of these pillars range from prescribing habits to naloxone, the overdose antidote. The solution also must be organized across communities because much like a virus, this disease doesn’t care about political healthcare delivery boundaries. 

At Northwell Health, we have assembled a multidisciplinary team to approach this problem that affects all of our communities, from Westchester, through New York City, to the eastern end of Long Island in Suffolk County. This is an integrated approach that crosses disciplines — from doctors to nurses to social workers — to tackle this problem with many causes. The task force’s strategy is based on the four pillars mentioned: limiting supplies, awareness of addiction risk, identifying and managing dependence, and treating opiate addiction. Key elements of our approach have been used for a range of health hazards: screening, brief intervention and referral for treatment — also known as SBIRT.

Screening is essential as it offers an opportunity to intervene before a crisis occurs. In addition, it allows medical workers to proactively recognize those at risk of an overdose rather waiting for an emergency. Recognition and action at points of entry into the healthcare system are analogous to our approach to communicable diseases, such as SARS and Ebola. When there is a risk of one of these diseases, we monitor all incoming patients.

Similarly, the use of a risk assessment tool by providers at the time of prescribing will alert them to those patients who are at higher risk of addiction from even short trials of opioids. A foundational element of this strategy is the development of tools to measure risk. This allows us to spot those at risk and measure if we are actually improving the problem.

Another important element is working with law enforcement. Partnering with local district attorney’s office is critical to approaching this as a disease — not a criminal matter. Clearly, drug dealers must be addressed separately, but most people who overdose are victims, not criminals. 

The current epidemic differs from previous drug problems in four significant ways. First, the start for most people is with prescribed drugs, not recreational drugs. Second, most patients have dependency, a physical need to take the drug to avoid withdrawal, not addiction. Third, as we have decreased the number of prescribed opioids the availability of cheap heroin has complicated the issue significantly. Finally, the danger of this epidemic is compounded by the introduction into the market of devastatingly powerful drugs, such as fentanyl variants, mixed with the heroin.

The opioid epidemic can be mitigated, but not solved, with current knowledge and the expansion of available resources. What is missing is a national strategy, commitment and funding. How many more parents must bury children? How many children have to become orphans? The healthcare debate in Washington is important — but this issue is overshadowed.

Congress, if you can move past a partisan debate on healthcare, you could make real progress on this issue. Think of how proud you would be to tell your children and grandchildren that you did.

Mark P. Jarrett, MD, MBA, MS, is the Senior Vice President and Chief Quality Officer ofNorthwell Health and a fellow ambassador of the New York Academy of Medicine. 


The views expressed by contributors are their own and are not the views of The Hill.