Friday, September 27, 2019

Opioid harm reduction: A comprehensive approach

By DR. DAVID J. HOLCOMBE | Medical Director, LDH Region 6

Opioid overdoses continue to claim over 100 American lives every day (46,029 in 2017). This slaughter now exceeds the number of annual traffic deaths (37,000 in 2017), which has benefited from gradual reductions related to improved safety in both roadways and vehicles. In an Annals of Internal Medicine article, Drs. Levine and Fraser proposed elements of a comprehensive public health response to the opioid crisis.

They established six categories to approach the crisis: (1) Leadership, (2) Partnerships, (3) Epidemiology, (4) Prevention/Education, (5) Treatment and Recovery and (6) Overdose Prevention. Some of the key elements of each category proved a framework for a coordinated approach in which public health plays a leading role.

Leadership entails the engagement of all leaders from the governor’s office down to community leaders, not only in healthcare, but also in education, corrections, social services and economic development.

Partnerships include not only those within communities, but also those between states, the federal government, faith-based organizations and health community coalitions, among others.

Epidemiology serves to create databases and dashboards available to all interested and engaged parties. The Louisiana Opioid Data and Surveillance System fulfills this valuable role by providing local data relating to specific populations.

Education and prevention involves prescribers, pharmacists and the public. This includes the state Prescription Monitoring Program, regulation of pain clinics, sanctions for over-prescribers, and working with school-based health clinics and the Department of Education to improve drug awareness.

Treatment and recovery must be enhanced with increased availability to rehab facilities, expansion of medication assisted treatment (MAT), use of telehealth in rural areas, and improved post-recovery programs addressing employment, housing, transportation and other social needs.

Harm reduction and overdose prevention must include safe syringe programs (such as one being proposed locally), increased availability of naloxone (Narcan®), and improved diagnosis and treatment of underlying pre-disposing mental health factors such as depression.

This ambitious plan reflects a multi-faceted approach and broad engagement from multiple elements of society. It recognizes the importance of social determinants such as educational level and income, as well as the necessity of addressing glaring issues of health inequity. Public health can have a primordial role in tackling the opioid epidemic, but it cannot act alone or in a vacuum. We all helped create the world of opioid addiction in one way or another, and now we must rise to the occasion to help mitigate and eradicate it.

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