The breadth of topics discussed Oct. 30 at Abt Associates’ Bold Thinkers Series event on opioids reflects the breadth of areas that must collaborate to stem the epidemic. The event--“Opioid Response: What Will It Take To Solve the Crisis?”--dealt with issues facing the public-health and justice systems, primary care givers and community organizations. The conclusion: many models must change to solve the crisis.
Panelists argued, for example, that the components of the response ecosystem mentioned above can’t operate in siloes. And they must integrate fast. “This is the biggest challenge faced in our lifetime,” declared Dr. Rahul Gupta, Commissioner and State Health Officer for the Bureau of Health, West Virginia Department of Health and Human Resources. “This crisis is unweaving the fabric of our society.”
Government agencies are recognizing the need for cross-cutting efforts. In one community, the Drug Enforcement Administration works with public health departments before a drug bust to prepare the health care/treatment system for individuals with substance abuse disorders who will face a supply shortage. Community support must be in place to help recovery of those leaving prison, Gupta noted. Similarly, social services must link with primary health care.
And primary health care must relearn everything. “In medical school, I was taught people in pain would not get addicted,” said Dr Joanna Starrels, associate professor at Albert Einstein College of Medicine and Montefiore Medical Center. Now she said, more primary care doctors are being trained in this area. Dr. Daren Anderson, director of the Weitzman Institute, advocated integration of behavioral health and primary care so that primary care physicians can understand a patient’s history and needs holistically. “There is no substitute for getting to know your patients,” he said.
Commander John Burke, president of the International Health Facility Diversion Association, suggested promoting integration by having law enforcement, prevention and rehabilitation personnel work together on a grant rather than compete for grants.
Medical practices also must evolve because addiction is different from other diseases. “Our healthcare system is built on the premise that people want better health, but in people with addiction, the brain has been rewired to want more of the drug,” said Dr. David R. Gastfriend, clinician and chief medical officer of DynamiCare Health. “The healthcare system must change to accommodate addiction.”
Prescribers, for example, identify pain but not addiction. And addiction treatment is segregated outside medical care though it is “a chronic, relapsing brain condition,” Gupta said. The judicial system must understand that, too.
Possible solutions: change insurance payment models, integrate behavioral health and primary care and recognize that on the pain scale, zero shouldn’t be the goal. “Pain is the body’s normal programmatic signal,” said Gastfriend.
Pain should not be the norm for families and communities seared by the epidemic. The scale of the crisis is prompting research that is leading to evidence-based treatments that work. That’s the good news about a scourage for which good news is rare.