Panel, Fireside Chat, Conference Presentation
A State of Emergency: Integrative Approaches to Addiction and the Opioid Epidemic
Milken InstituteDavid Beier, Jerome Adams, Terry McAuliffe, Lori McFarling, Tom Moriarty, Nora Volkow, Tammy Wincup
- Economic Impact of Prevention: Investment in prevention yields an economic return of $64 for every $1 spent, according to the session's opening statistics.
- Federal Response in Puerto Rico: 14,000 federal officials are deployed in Puerto Rico and the US Virgin Islands to manage the transition from hurricane response to recovery, addressing pre-existing high rates of opioid addiction and depression.
- Social Capital Resilience: A report is being planned by the Surgeon General to demonstrate that communities with strong investments in social capital (business, government, and NGO partnerships) recover more quickly from crises like hurricanes and opioid epidemics.
- Discovery Education "Operation Prevention": A collaboration with the DEA launched in September 2016, targeting grades 3–12 with multimedia content covering the science of addiction from trial to dependency.
- Scale of Educational Reach: Discovery Education serves approximately 50 million students and 4.5 million educators, with over one-third of US classrooms connected to their services.
- Partnership Mandate: The initiative aims to embed opioid prevention into existing curricula (science, social studies) to avoid adding to teacher workloads, targeting a total open-access model where no cost is required for schools to use resources.
- CVS Pharmacist Training & Disposal: CVS invested hundreds of millions of dollars to train pharmacists on opioid abuse, having removed over 100 metric tons of unwanted pharmaceuticals via police station partnerships in the last two years.
- Take-Back Expansion: CVS plans to expand its drug take-back program to 750 pharmacy locations nationwide by the end of the next year.
- Patient Counseling Initiatives: New protocols require extra counseling for "opioid-naive" patients on first fills for acute pain to emphasize taking only the necessary amount and disposing of leftovers safely.
- Prescription Limits: Starting in February, CVS Caremark will limit first fills for new opioid prescriptions to seven days for roughly 100 million lives across their plan sponsors.
- NIDA Statistics: The US saw 64,000 overdose deaths in 2016, a 22% increase from 2015, while 88,000 people die annually from alcoholism and its consequences.
- Clinical Complexity: Unlike other addictions, opioid use originated within the healthcare system to treat pain; removing opioids entirely without providing alternative pain management modalities risks undertreating legitimate pain patients.
- Coordination Challenge: The Assistant Secretary for Mental Health and Substance Abuse within HHS has been designated as the coordinating entity for federal efforts, though a grassroots solution is deemed necessary due to the epidemic's multifactorial nature.
- Surgeon General's Personal Testimony: The Surgeon General noted possessing over $5,000 worth of unused opioids in his own home from past procedures, highlighting the difficulty of finding safe disposal sites prior to recent expansions.
- Virginia State Statistics: Virginia recorded 1,100 opioid-related deaths last year, with distinct geographic drivers: opiates in the west (coal country) and fentanyl/heroin in the east.
- Virginia Legislative Action: Virginia has implemented a 10-day limit on initial opioid prescriptions (requiring written explanation for extensions), resulting in a one-third reduction in morphine-related over-prescriptions in six months.
- Buprenorphine Reduction: New regulations in Virginia limiting the abuse of buprenorphine have led to a 35% drop in abuse-related incidents for the drug.
- Economic Workforce Impact: Governor McAuliffe noted that while unemployment in rural Virginia has dropped, full employment is hindered by the opioid crisis, as 60–70% of job applicants in some regions fail drug tests.
- Cost of Incarceration: Incarcerating opioid offenders costs approximately $24,833 per prisoner in Virginia, whereas drug court programs are estimated to save hundreds of thousands of dollars per individual over time.
- EverFi Data Gap: EverFi highlighted a critical lack of longitudinal data sets regarding prescription drug safety outcomes for youth and college students, necessitating a shift from mere awareness campaigns to efficacy-measured interventions.
- Adverse Childhood Experiences (ACEs): Up to 50% of adults have experienced three or more ACEs, a key predictor of substance misuse; the session emphasized that one positive adult influence can mitigate these risks.
- Data Analytics Compact: 46 of 50 state governors have signed a compact to share data and invite private tech companies to perform analytics on prescription trends and local flare-ups.
- Private Sector Data Leverage: The panel identified private entities like CVS and Express Scripts as holding granular prescription data that exceeds public Prescription Drug Monitoring Programs (PDMPs), urging public-private partnerships to close data gaps.
- Stigma Shift: The panel noted a declining stigma among youth regarding prescription opioids (e.g., ADHD meds) compared to the historical stigma associated with alcohol or illicit drugs.
- Regional Collaboration: Virginia is actively coordinating with Maryland, Washington D.C., and West Virginia, acknowledging that the opioid crisis transcends state borders.