Five ways the US is fighting its opioid crisis

Donald Trump’s rhetoric on the opioid crisis sweeping rural America has been radical. The president declared the wave of overdose deaths a national public health emergency in October 2017, a proclamation he’s since renewed several times.

But the sound and fury of the new “war on opioids” hasn’t always been accompanied by action.

The reality is that major new funds — like the $100billion proposed in Democratic Senator Elizabeth Warren’s legislation — have little chance of emerging from a dysfunctional Congress. But the government is nonetheless making moves to address the crisis, with less headline-grabbing steps that could still make a real difference. Here are five of them.

1 — Giving communities tools to understand their challenges

Although the scale of the opioid crisis is now well known, many of the most affected areas are small rural municipalities which lack the resources and expertise to come to grips with how substance abuse is affecting them.

The US Department of Agriculture (USDA) launched its new Community Assessment Tool in October, to help rural communities develop an insight into the way the opioid crisis is affecting their residents.

“Local leaders in small towns across our country need access to user-friendly and relevant data to help them build grassroots solutions for prevention, recovery and treatment,” said Anne Hazlett, head of rural development at USDA.

The tool maps the drug overdose rate in counties across America for different time periods, and allows users to overlay that data with information on demographics, educational attainment and socioeconomic status.

The Department of Health and Human Services is also creating a dashboard which will give public users access to detailed data on substance abuse, particularly of opioids.

2 — Improvements to recovery care

As the opioid crisis has developed, some community healthcare providers have developed innovative ways of spreading expertise on addiction from specialists to the primary care doctors on the frontlines.

The federal government has started working to make those best practices more common across the country. Project ECHO is a program originating in New Mexico, where it focused on hepatitis C, which connects groups of doctors by videoconference with specialists to discuss different cases and build their knowledge of the new problems they’re encountering.

Project ECHO, and its expansion to cover opioid and addiction-related specialisms, has been widely feted as a model for helping physicians in rural areas deal with complex and unfamiliar cases.

Now it’s been specifically named in new legislation creating a grant program for the establishment of comprehensive opioid recovery centres, to coordinate care and service delivery using telehealth technology. The new grants will help spread that good practice and mean more primary care doctors are able to provide effective help to patients struggling with pain and opioid addiction.

3 — Coordinating agencies to detect illicit opioids

While the origins of the opioid crisis lie in prescription drugs, in recent years illicit drugs have overtaken prescribed ones as the major killer in the US. Almost half of opioid overdose deaths in 2017 involved illicit fentanyl.

To help respond to this shift, the federal government is piloting a new program in public health and drug laboratories to improve the detection of fentanyl and other synthetic opioids like it.

The pilot will increase the attention public health laboratories give to synthetic opioid testing and identification. But more importantly, it aims to coordinate their work with laboratories run by law enforcement. That will mean police and border officials are updated on new trends in opioid misuse and have the tools to more reliably detect and intercept illegal opioids.

4 — Learning more about pain and addiction

Underlying the opioid crisis is a chronic pain crisis, which has left millions of Americans reliant on prescription painkillers. So a vital step in tackling opioid overdoses is understanding more about ways to treat pain and manage addiction.

The government now has a bevy of programs in place to help develop and spread understanding about addiction and pain.

A grant program first authorised in 2016, and renewed this year, gives training to emergency services personnel on opioid misuse. It aims to increase the use of naloxone, a drug which can reverse overdoses if quickly administered, and improve knowledge among first responders about safety around newly-widespread opioids like fentanyl.

New legislation signed by the president in September directed the Department of Health and Human Services and the Food and Drug Administration to develop guidelines for doctors and hospitals, to reduce unnecessary opioid use. The guidelines are intended to broaden awareness of good practice with opioids among physicians.

And the same legislation creates new research projects, in the National Institutes for Health and other federal agencies, to identify advances in treatment of chronic pain and addiction and share their knowledge.

5 — Creating a guide to different programs and funding sources

A strategy of incremental steps and awareness-raising can make a real difference — but it faces the risk of fragmentation. For people working at the community level, whether in local government, hospitals or law enforcement, the array of grants and programs available can be difficult to navigate.

The Department of Agriculture last month took a step towards unifying that array of policies, with its new Rural Resource Guide. Produced by an inter-agency working group which is trying to coordinate the efforts of different federal bodies, the guide offers a one-stop-shop for people in rural communities looking for federal funding and partnership.

“Strong and healthy communities are a cornerstone for prosperity in rural America,” Anne Hazlett of USDA said. “Under the leadership of President Trump, USDA is committed to empowering rural leaders with tools to better leverage state, local and private resources with federal investment.”

(Picture credit: K State/Flickr)