We invited speakers to participate in a roundtable discussion on Saturday that was geared towards identifying specific challenges people were having within their particular field or profession regarding the opioid epidemic. One of the main takeaways from this session was that despite significant differences in their areas of work and research, everyone was facing similar roadblocks to providing individuals with opioid use disorder the help and resources they need. We wanted to share these roadblocks with you all, along with potential solutions where they were suggested. To be clear, these are not the views of any one person or necessarily of all of the speakers but are a summary of general points made and discussed.
§ “Being Siloed.” Every person at the table felt their effectiveness was impacted by a lack of practical and coordinated connection to individuals working in other disciplines and fields. The opioid epidemic is a massive, multifaceted, and constantly changing public health crisis and in order to intervene successfully in mitigating its damage it’s imperative that people work together rather than remaining siloed in their area. There is a need for interdisciplinary conversation and exchange, not just talk but coordinated programs and grants that utilize knowledge and ideas from multiple areas of expertise.
§ Legislative Reform. Researchers, clinicians and providers are impacted by legislation that often lags behind both advancements in the field and the constantly changing crisis. Specific areas of reform mentioned were increased NIH funding for addiction research; antiquated paraphernalia laws being removed on the state and federal level; and laws requiring physicians to obtain X-Waivers to prescribe Buprenorphine (when, for example, no education is required to prescribe opioids) being struck down.
§ Improved training and education about substance use disorder. The point was made that in many areas we don’t need new approaches to the opioid crisis – we need a more mainstream understanding of the already substantial body of addiction studies along with substantially increased access to successful modes of treatment that already exist. Cultural and racial stigma around substance use disorder is rampant on all levels of American society. There is a need for targeted education of healthcare professionals about substance use disorder and treatment; targeted education of lawmakers who are creating restrictive and punitive legislation based on limited and often stigmatized understandings of substance use disorder; and education and training of first responders such as the EMS and police who currently receive minimal training for dealing with individuals with mental health and substance abuse issues that comprise a large part of their work.
§ Research Funding. Compared to other health crises, such as cancer, addiction research is substantially underfunded in the United States despite the fact addiction is one of the highest health-related financial costs to the country. Researchers and providers discussed frustration at the current grant funding system, which can be inefficient and prevent novel and interdisciplinary research from being funded, particularly by younger researchers who do not have an established record of funding. Suggestions included rolling grant submissions and mitigating the bottleneck of peer review by both increasing the number of study sections and by creating more discipline-specific and targeted study sections at the NIH.
§ Coordination of services. Pharmacological intervention is only one component of treating substance use disorder while it receives a large portion of funding. There is a substantial need for coordination of medical, mental health, and social services for individuals suffering from substance use disorder, most of who have co-morbid health and psychiatric issues and many of whom live in poverty. Services that have established outcomes need to receive more funding.
§ Alternative Pain Treatment. There is a substantial need for education and training in the healthcare arena about alternatives to opioids for pain treatment. While pharmacological alternatives to opioids; surgical techniques such as nerve blocks; and alternative treatments, like acupuncture, have shown to be effective in reducing pain, widespread education of physicians in these areas as well as insurance coverage for these treatments is necessary for them to make an impact on not just the reduction of opioid prescriptions but the successful management of individuals' pain.
§ Harm Reduction. There is an overwhelming emphasis on treatment of and recovery from substance use in the United States, much of which is based on abstinence only models of recovery. In reality, full recovery isn’t an achievable or desirable goal for many users. A century of failure has shown the US can’t eradicate drug use. We need to find ways to keep those using opioids safe, disease free, and alive. Harm reduction measures – many of which are prevented through legislation – include needle exchange, safe injection sites, widespread access to naloxone, access to Hepatitis-C vaccines and treatment, and access to fentanyl test strips.
§ Social Reform. Poverty and its attendant physical and psychological traumas are major drivers in opioid use specifically and all substance use more generally. Unless meaningful social reform is instituted in the United States, which has an increasing number of individuals living below the poverty line each year, substance use will continue to rise.
While this list reflects that there are substantial, and in some cases seemingly insurmountable, issues that need to be resolved in order to reduce the impact of the opioid epidemic it also reflects there are actionable solutions. We hope to be part of the solution by both continuing the interdisciplinary conversation and exchange and increasing research in this area. We look forward to sharing our plans for the next opioid meeting with you soon.