By Jeffrey Kiyoshi Hom, MD, MPH March 17, 2017
Tags: CHERISH and PennLDI
This post originally appeared on the University of Pennsylvania Leonard Davis Institute Health Policy$ense blog on March 8, 2017.
Opioids have emerged as one of the greatest public health threats facing the United States. Nationally, fatal overdoses involving opioids have quadrupled since 1999. Opioids contributed to over 33,000 deaths in 2015 alone.
In Philadelphia, the numbers are equally sobering. Although the final toxicology reports are pending, approximately 900 deaths in 2016 have been attributed to unintentional drug overdoses, three times the number of homicides. Eighty-percent of these deaths involve opioids, including heroin and fentanyl, an extremely potent synthetic opioid painkiller. In 2014, Philadelphia County’s fatal overdose rate of 33.1 deaths per 100,000 persons outpaced other counties with large cities, including Wayne County (Detroit, 25.9), Allegheny County (Pittsburgh, 25.7), Baltimore County (Baltimore, 22.9) and Suffolk County (Boston, 17.1). In response to these alarming trends, Mayor Jim Kenney convened city-wide Task Force in January 2017 to look at the problem in Philadelphia and make recommendations for what can be done.
But there’s more to the opioid crisis than the numbers. Everyone has their own story. And as a policy advisor in the Philadelphia Department of Public Health focusing on opioids, I often hear these deeply personal and often tragic stories:
“Oh, you’re working on opioids? It’s so sad. One of my friend’s grandsons died of an overdose…”
“I got so many Percocets after my wisdom teeth were taken out. Those pills are strong…”
“Why did they give me so many pills after my operation? The pain wasn’t so bad after the first few days…”
“Yeah, it seems like this problem is everywhere. One of my old co-workers now uses heroin…”
An April 2016 survey by the Kaiser Family Foundation found that 4 in 10 Americans know someone who has been affected by the opioid crisis. I have little doubt that that number is even higher now. Should we be surprised when Americans make up 5% of the world’s population yet consume roughly 80% of the world’s opioids?
"I too directly knew someone who died from his prescription opioid addiction. It is all too common a story. That everyone has their own story about opioids is heartbreaking. Has any other illness so deeply penetrated the lives of everyday Americans? How many families have been disrupted or damaged by this epidemic? How many more will be?"
At the Philadelphia Department of Public Health (PDPH), we’re striving to address the problem through three complementary approaches: reduced opioid prescribing, increased access to drug treatment (including medication assisted treatment with methadone or buprenorphine), and increased access to naloxone, a medication that rapidly reverses the effects of an opioid overdose. Given the tremendous complexity of the problem, PDPH is also working closely with other city agencies, community organizations and stakeholders across the city and state.
Recognizing the importance of using data and evidence-based practices to inform our approach and evaluate our progress, we hope our partnerships will also include academic institutions to a greater extent, whose insights, knowledge and expertise can help answer many policy-relevant questions facing us today, including:
- How do we accurately measure heroin use in Philadelphia?
- What is the economic cost of drug use in Philadelphia?
- What approaches can health care systems take to support more judicious prescribing of opioid painkillers?
- Can incentives help encourage patients to return unused prescription medications? How?
- What strategies are most effective in distributing naloxone in vulnerable communities?
- What policy and practice barriers exist in Philadelphia to more physicians prescribing buprenorphine?
- What messages resonate with Philadelphia communities that will reduce the stigma associated with substance use disorders?
Decreasing the morbidity and mortality from opioids will not be an overnight fix. Despite making national headlines only relatively recently, the opioid problem been building for years and will take years to address. Tough questions must be asked and answered. But I believe we will get there through the concerted efforts of us all. Let us collectively find the resolve to address this crisis before the statistics rise much higher and more people – our family members, friends, colleagues and community members – have their own stories to share.