Oct 23, 2018, 3:04 PM ETConference Presentation, Panel

Opioid Crisis: Examining National, State, and Local Responses and Impact

Event Context: The discussion took place at the Milken Institute Future of Health Summit, featuring Dr. Nora Volkow (NIDA), Dr. Sharif El-Nahal (NJ Dept. of Health), Dr. Eleanor McCance-Katz (SAMHSA), and Dr. Thomas Graff (Horizon Blue Cross Blue Shield).
Core Consensus: All panelists agreed that the opioid crisis is heterogeneous, requires a multi-trajectory approach rather than a single "magic bullet," and demands collaboration between government, insurers, providers, and communities.

Heterogeneity of the Epidemic

Dr. Volkow: The epidemic varies geographically and demographically; for example, Massachusetts faces high mortality from heroin/fentanyl despite good prescription practices, whereas Appalachia originated with prescription opioids.
Dr. Volkow: Addiction pathways differ: some individuals become addicted after legitimate prescriptions, while others seek prescription drugs for euphoria and transition to heroin or fentanyl.
Dr. McCance-Katz: There is a high rate of co-occurring mental illness; over 60% of people with opioid use disorder have a co-occurring mental illness, and 25% have serious mental illnesses.

Strategic Shifts in Treatment & Prevention

Dr. El-Nahal: New Jersey is implementing a "whole trajectory" approach, addressing intervention points from initial exposure through the criminal justice system to death.
Dr. El-Nahal: New Jersey is utilizing medical marijuana as a tool to treat pain in ER and primary care settings to reduce initial opioid prescribing, despite federal scheduling barriers.
Dr. El-Nahal: The state is expanding medication-assisted treatment (MAT) within county jails and correctional facilities to prevent overdose upon release, filling gaps left by federal Medicaid restrictions during incarceration.
Dr. Graff: Insurers are redirecting funds away from non-evidence-based urine drug testing (where 30% of testing is for members with >25 tests/year) toward effective treatments like MAT.
Dr. Graff: Horizon Blue Cross is moving toward payment models that allow providers flexibility to individualize care over 12–18 months rather than mandating rigid 30-day stays.

Data, Infrastructure, & Measurement

Dr. El-Nahal: New Jersey is constructing the "New Jersey Health Information Network" to integrate electronic health records and vital statistics for real-time data, moving beyond lagging medical examiner data.
Dr. El-Nahal: The state allocated $100 million for infrastructure, with a significant portion dedicated to building real-time data collection systems to track overdose hotspots and treatment demand.
Dr. McCance-Katz: SAMHSA is instituting client-level data collection to track specific parameters like patient engagement and retention, noting that treatment durations under six months are often ineffective.
Dr. McCance-Katz: The administration is reinstituting the Drug Abuse Warning Network (DAWN) to collect hospital data on substance use toxicities beyond just overdose deaths.
Dr. Graff: The insurance sector lacks granular quality definitions for substance use treatment, making it difficult to compare provider success rates or direct patients to the "best" care.

Federal Initiatives & Training

Dr. Volkow: There have been significant increases in the prescribing of buprenorphine, extended-release naltrexone, and naloxone distribution over the last 15 years.
Dr. Volkow: A major victory is the shift in healthcare systems to screen and treat individuals in primary care and emergency departments, rather than relying solely on incarceration.
Dr. McCance-Katz: SAMHSA has embedded "Data Waiver" training (required for prescribing buprenorphine) into medical schools, PA programs, and nurse practitioner curricula to mainstream addiction education.
Dr. McCance-Katz: The agency is providing technical assistance teams in every state to help local organizations implement evidence-based practices tailored to their specific communities.

Emerging Risks & Future Outlook

Dr. Volkow: While opioid fatalities are a primary focus, there are rapidly increasing fatality rates associated with cocaine and methamphetamine that must also be monitored.
Dr. Volkow: The ultimate goal is to decrease overdose fatalities, but the broader victory is addressing the underlying problem of addiction across all substances, including alcohol and tobacco.
Dr. McCance-Katz: Success metrics must include not just reduced deaths but improved patient outcomes, such as reduced toxicities and sustained recovery.

New Jersey Policy: The state has mandated that all medical school graduates be trained in Medication-Assisted Treatment (MAT).
Insurance Reform: Horizon Blue Cross is implementing a payment policy to cease reimbursement for urine drug tests not part of a bona fide, evidence-based treatment plan.
Criminal Justice Integration: New Jersey is funding MAT purchase and care navigators for county jails to ensure continuity of care post-release.
Dr. Volkow: "Never become complacent; the crisis changes rapidly, and no single solution works for every situation."
Dr. El-Nahal: Success requires respecting local "home rule" and organic community partnerships rather than imposing top-down solutions.
Dr. McCance-Katz: Policymakers must "get out of Washington" to listen directly to those living with substance use disorders to direct effective policy.
Dr. Graff: Insurers must avoid acting as "big brother" by micromanaging care; instead, they should enable provider systems with flexibility and resources.
Dr. Volkow: Collaboration is fundamental; scientific advances are meaningless if not integrated through partnerships between government, private industry, and communities.