By John Alexander Short
Dr. Monica Bharel, the Commissioner of the Massachusetts Department of Health, recently hosted a webinar panel to discuss the many consequences of the modern opioid epidemic on families.
Hosted jointly by the Association of State and Territorial Health Officials (ASTHO) and The Forum at the Harvard T.H. Chan School of Public Health, the event also included Dr. Stephen Patrick, Dr. Karen Remley, and Dr. Michael Warren who joined Bharel for a talk titled “State Health Leadership: Understanding & Responding to the Lifelong Effects of Opioid Exposure for Infants, Children & Families.”
The discussion offered insight into the complex nature of addiction and the need to understand the disease to craft effective solutions.
The panelists each addressed a number of related issues concerning the modern opioid epidemic ranging from underlying social contributors of substance abuse to institutional solutions to substance use disorder. One particular point of discussion concerned Neonatal Abstinence Syndrome (“NAS”), a group of related problems in newborns born dependent on opioids.
Interestingly, this tragic consequence of the modern opioid epidemic occurs almost entirely within the healthcare system. As such, leading healthcare officials are able to access data and potentially begin to formulate solutions to the issues underlying the opioid epidemic by analyzing trends of NAS.
Bharel began by discussing data about the opioid epidemic in Massachusetts and specifically identified a need for careful and continued care for individuals with substance use disorder, noting the success rates of individuals who engage in Opioid Agonist Treatment (OAT).
Dr. Stephen Patrick, Director of the center for Child Health Policy and an Assistant Professor of Pediatrics and Health Policy at the Vanderbilt University School of Medicine, spoke at length about an increase in the rate of NAS in his practice. Discussing pregnant mothers with opioid use disorder, Patrick pointed out that studies show there is limited access to treatment options (i.e., buprenorphine, methadone) for pregnant women. He pointed out how this population is especially vulnerable due to this lack of insurance coverage.
Dr. Karen Remley, CEO and Executive Vice President of the American Academy of Pediatrics and the former Commissioner of Health for Virginia, discussed how addictions often develop during adolescence and youth, which are particularly delicate times of life. She also discussed the difficulties of stigma associated with the opioid epidemic.
Dr. Michael Warren, the Deputy Commissioner for Population Health at the Tennessee Department of Health, focused primarily on the role public health programs can play in addressing the issues underlying the modern opioid epidemic. He spoke of his experience with the Tennessee Department of Health and their response to NAS, and noted they have some of the most up-to-date, real-time data of any state in the country of the incidence of NAS.
Perhaps the most unfortunate, and arguably foreseeable, impression from this discussion is the breadth of the modern opioid epidemic. Indeed, the most recent data from the Center for Disease Control reports over 42,000 overdose deaths occurring in the United States in 2016.
As the webinar made clear, the issues involved with and surrounding substance use disorder are complex. Whether addressing the underlying causes, treating the individual facing the disease, or educating the countless people affected by the epidemic, the complexity of the issue may very well feel daunting. Moreover, issues surrounding the opioid epidemic are urgent. Dr. Bharel pointed out that it only takes an average of 36 months from an individual’s first exposure to opioids until that individual faces a high risk of death. Altogether, this means the approach required to begin tackling these problems will need to be careful, methodical, and consistent.
An interesting point of discussion involved the underlying causes of the so-called “diseases of despair,” which encompass not only surging addiction levels, but also deaths from alcohol, violence, and suicide. In response to the question of what may be the root cause of such an increasing rate of overdose deaths, panelists referenced increased levels of isolation in the modern world. Whether it is possible (or even prudent) to attempt to increase the level of social inter-connectedness is a question for another webinar, but nonetheless raises interesting questions. Is there an aspect of modern life that contributes to the modern opioid epidemic?
Considering this question, I am reminded of a saying used by individuals facing addiction: “The opposite of addiction is not sobriety, but community.” Indeed, the panelists discussed the meaning of family and how important it can be to have a trusting adult in one’s life during formative years. Perhaps one of the solutions to the modern opioid epidemic will involve addressing the absolute need for community.
Another important and interesting way to address the opioid epidemic is through Opioid Agonist Treatment (buprenorphine, methadone), which can decrease mortality rates by 50 percent. Perhaps tellingly, Dr. Bharel shared that despite the success of OATs in treating substance use disorder, OATs are not viewed by medical professionals simply as life-saving treatments, as any other medicine with similar efficacy rates would be. Attitudes like this by medical professionals reflect existing stigmas within medical communities that serve to prevent progress in finding solutions.
These attitudes reveal the profound effect stigma may have in addressing these issues. Indeed, the opioid epidemic faces particular issues relating to stigma. Those using opioids may feel pressure to keep their substance abuse secret from those around them. Families affected by SUD may wish to keep the problem secret within their community. Stigmas also exist in the medical arena, where doctors or even insurance companies may be less willing to treat or cover issues relating to substance abuse disorder. This leads to the obvious question of how to address a problem no one is willing to admit exists.
Discussions like this webinar are an important step to better understand the problems relating to the opioid epidemic.