Conference Presentation, Panel, Fireside Chat
Opioid Addiction: A Crisis Fueled by Stigma
Milken InstituteSarah Karlin-Smith, Kelly Clark, Gary Mendell, Andrey Ostrovsky, Nora Volkow, Ronnie Solomon, Michael Golinkoff
- The opioid crisis is projected to persist at extreme mortality levels without specific interventions, with panelists anticipating a 50% reduction in mortality within 1.5 years through integrated evidence-based interventions in four high-mortality states.
- Shatterproof plans to launch a major stigma project involving a three-to-four month pro bono McKinsey study on social change models, expecting mass adoption if 1,000 US companies share addiction stories bi-annually to influence 30 million people.
- Seven key success factors are identified for reducing stigma within six systems (employers, healthcare, criminal justice, media, government, local communities), alongside a strategy to implement three to five easy actions across these sectors to drive change.
- Gary Tan advocates for increasing the National Institutes of Health NIDA budget from $1.4 billion to $2.5 billion (matching cancer funding) or $4 billion (matching heart disease funding), aligning with the prevalence of substance use disorders relative to other major diseases.
- Significant barriers to OUD treatment include 60% of facilities not utilizing medication, Medicaid loss for inmates leading to re-entry treatment gaps, and the Bureau of Prisons being grossly underfunded.
- Policy expectations include treating addiction as a disease rather than criminal behavior, educating judges on clinical evidence, eliminating 42 CFR data sharing restrictions (excluding law enforcement without subpoenas), and expanding Medicaid as an immediate policy win.
- Dr. Nora Volkow emphasizes the need to expand research on recovery distinct from treatment, invest heavily in addiction research similar to HIV antiretroviral initiatives, and integrate patients and families to address internalized stigma.
- Settlement funds, such as the $500 million from J&J, require specific legal language to ensure they target the addiction crisis rather than general state budgets, though current infrastructure lacks the staffing and modalities to deploy evidence-based treatment effectively.
- Two bodies of work from the National Academies of Medicine regarding prevention, treatment, and recovery systems are expected within six months to outline current and ideal states.
- While health plans have positively increased medication-assisted treatment, availability remains the primary barrier, and the Rhode Island study is expected to show decreased overdose rates through inmate medication choices.
- Panelists note that while sharing recovery stories with criminal justice implications may improve policy, it could inadvertently worsen stigma, whereas incorporating research into media and health insurance supply chains is expected to eliminate stigma.