Hudson: How to End the Opioid Epidemic? Contain, Reduce, Extinguish

By: John Cole

Reading Time: 2 minutes

Date: 05/25/2017

Filed Under: Opioid Epidemic

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The Hudson Institute’s recent briefing paper, “A Strategy to Counter the Opioid Epidemic: Contain, Reduce, Extinguish” delivers a clear explanation of our nation’s opioid problem, and importantly, a comprehensive approach to address the issue.

According to Hudson, the national problem breaks into three substance profiles, with each presenting a unique threat:

  1. Illicit opioid markets and use, traditionally heroin
    1. Heroin overdose deaths have increased 327% since 2008.
    2. It has become much more abundant nationally while also becoming more pure and potent, while price continues to decrease.
    3. Demographics of those using have shifted from largely minority/inner-city to a much broader social/racial/ethnic/geographic dispersal.
  2. Misused (or diverted) prescription pharmaceutical opioids, often related to medical practice
    1. Overdose death rates have mostly stabilized.
    2. This trend is likely the result of efforts to limit prescribing—Prescription Drug Monitoring Programs (PDMPs) have reduced “doctor shopping” and “pill mills”—and the supply of prescription opioids has sharply declined.
    3. These are often legitimate medicines helping patients who suffer from severe chronic pain, so there must be a balance so as not to impede those who legitimately need these medications.
    4. There is evidence that suggests some initial users of prescription opioids transitioned to illicit opioids (or whatever the market could provide) when faced with constraints, i.e. cheaper.
  3. Novel illicit synthetic opioids, such as fentanyl and its analogs, which are remarkably lethal
    1. Use of synthetic opioids is rising rapidly and fatally—they will soon eclipse heroin as a cause of overdose deaths (deaths associated with synthetics rose 79% between 2013 and 2014, and that sharp rise continues today.)
    2. They are of chemical manufacture, making production difficult to detect, and true potency unknown to the user.

Our Nation is in the middle of its deadliest drug crisis ever. The threat is well noted and publicized. What this paper added was a call to action:

“Strategic efforts against the opioid threat require much better information. Current data are inadequate to measure the impact of policies. Consider that at this writing in early 2017, national reporting from the CDC on drug overdose data is no more recent than the end of 2015. Evidence for increased deaths for 2016 has already been observed at the state level, but it is not yet compiled on a national basis.

Under these conditions, the impact of policy changes effected this year will not be reported until 2018-19, at the earliest. This is utterly inadequate to combat a rapidly moving epidemic.

To contain and counter the epidemic, individuals working at the federal, state, and local level need a national surveillance and monitoring system, approaching real-time reporting, with local geographic coding and mapping.

In addition, since existing federal data sets are retrospective and lacking in geographic and temporal texture, authorities need to develop additional and novel monitoring and data-set capacities able to detect (and even predict) emerging trends.

Establishing a common, detailed understanding of the epidemic in real time is critical to deploying effective responses to contain and reverse the current rates of addiction and death.

At AffirmHealth, we've written extensively on solving the opioid epidemic in recent months. For more, download our latest ebook by AffirmHealth Chief Medical Officer Mario Ramirez, MD:

Download Solving the Opioid Epidemic: A Clinician's Perspective

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