Fireside Chat, Panel, 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, Indra Nooyi, Scott Gottlieb
- The Surgeon General anticipates publishing a report demonstrating that investment in health and social capital builds community resiliency against events like hurricanes or the opioid epidemic, while communities lacking such investment struggle to recover; the outlook emphasizes transitioning from directives to grassroots solutions and improving inter-agency coordination, including leveraging granular industry data from entities like CVS and Express Scripts.
- Future strategies for the office center on "better health through better partnerships" involving government, NGOs, and businesses, with the new Assistant Secretary for Mental Health and Substance Abuse designated as a coordinating entity for federal efforts to enable real-time, evidence-based program application in high-need areas.
- Discovery Education plans to launch Operation Prevention as a multi-media initiative for grades three through 12, embedding opioid education into science, social studies, and social-emotional learning with the goal of engaging over a million students, providing immediate, open-source access to resources without sponsorship, and aligning content with NGSS, C3, and SOEL standards.
- The state health officer intends to move opioid prevention upstream by integrating programs into existing instructional standards to avoid adding grading burdens to teachers, while also ensuring access to resources during non-instructional times.
- CVS expects to expand its drug take-back program to 750 pharmacies by the end of next year and will limit first fills for acute pain to seven days for the roughly 100 million lives managed by Caremark starting in February, alongside new counseling initiatives for medical professionals and parent programs.
- The opioid crisis trend shows a 22% increase in substance use disorder deaths from 2015 to 2016, with NIDA noting that the healthcare system must take responsibility for prevention to avoid future occurrences.
- Panelists predict pushback against prescriber limits unless alternatives such as physical, art, or music therapy are funded, warning that restricting access without these options will cause undertreated pain and increased disparities in specific groups.
- A comprehensive approach is expected to address adverse childhood experiences (ACEs), noting that up to 50% of adults have experienced three or more such events, with resiliency mitigation strategies focusing on ensuring at least one positive adult interaction for children and educating the "healthy majority" to intervene.
- Governor McAuliffe plans to implement evidence-based practices across Virginia, Maryland, and D.C., including naloxone training and prescription limits, and expects to complete a compact with 46 of 50 governors to share data with tech companies for analytics while clamping down on fentanyl imports.
- Economic and educational goals include achieving full employment by addressing the crisis to fill 215,000 jobs, utilizing drug courts to save hundreds of thousands of dollars per person compared to $5,800 incarceration costs, and collaborating with universities to teach opioid dangers in K-through-12 programs.
- Private partnerships with federal agencies like NIH, CDC, and FDA are required to incentivize pharmaceutical investments in non-opioid medications, while the healthcare system structure must change immediately to reimburse physicians for comprehensive pain management treatments aligned with CDC guidelines.
- Risks to prevention efforts include stigma surrounding ADHD medication or prescription opioids, which hinders peer intervention, and the potential for increased disparities if the opioid "spigot" is turned off without providing legitimate pain alternatives.