This post originally appeared on the University of Pennsylvania LDI Health Policy$ense blog.
The opioid epidemic is a national problem, but solutions may be local. In Philadelphia, the Mayor’s Task Force to Combat the Opioid Epidemic recently released a report with 18 recommendations for a “comprehensive and coordinated plan to reduce opioid use disorder and its associated morbidity and mortality.” The report focuses on Philadelphia, but draws on data from states that have had success in curbing the epidemic. The task force worked as a city government entity, but also met with community organizations and held four “Community Listening Sessions” to hear from those most affected by the epidemic.
LDI Senior Fellows Michael Ashburn, Zachary Meisel, and Jeanmarie Perrone participated in the effort. Meisel and Perrone discuss the findings in the context of their experiences as emergency department physicians here.
The report is broken out into four categories: Prevention and Education, Treatment, Overdose Prevention, and Involvement of the Criminal Justice System. Here we highlight a number of recommendations that target physicians and other health professionals.
The report calls for professional schools and provider organizations to “require and have standards for broad, interdisciplinary competency-based training” in pain, pain management, and substance use disorder. Recognizing that education alone is not likely to change prescribing behavior, especially among established physicians, the task force also call on the City to support evidence-based interventions promoting more judicious opioid prescribing.
Beyond integrating substance use disorder treatment into all health care professionals’ training, the task force also recognized the need to expand the number of providers that specialize in this area. The report paints a dismal picture regarding the shortage of providers and hints at “incentivizing” health and social service professionals to specialize in substance use disorder treatment. This is an intriguing proposal, reminiscent of previously established programs like the National Health Service Corps that attempt to address the shortage of primary care physicians by offering loan repayment to medical students who enter primary care.
To meet the treatment needs of the 122,000 to 150,000 Philadelphians with substance use disorder, the task force recommends that treatment be offered to patients at every level of care, from outpatient to hospital-based services, emphasizing recovery initiation and engagement in sustained treatment. The report argues that eliminating the current distinction between detoxification and treatment centers would minimize the perceived unavailability of treatment programs and reduce relapse rates. It mentions comprehensive approaches to treatment in other ways as well, such as the need to include mental health services in physical detoxification and treatment.
A report itself cannot solve this crisis.
Mayor Jim Kenney
Given the proven effectiveness of Medication-Assisted Treatment (MAT), the report emphasizes the importance of initiating MAT immediately and maintaining it throughout patient transfers to different stages of recovery. This is known as a “warm handoff.” The task force also strongly endorsed expanding the use of the rescue medication naloxone, calling for increased availability beyond formally trained health care providers. The recommendation includes a public awareness campaign about naloxone, with City programs to purchase it and train lay people to administer it. Target audiences include people discharged from hospital emergency departments, prisons, and treatment programs.
The report rounds out its approach with recommendations that go beyond the health care system. It advocates for increasing the number and ease of access to treatment sites, safe permanent housing, recovery housing, and vocational support services for those in treatment. It also pays particular attention to the importance of the criminal justice system, calling for increased capacity for diversion out of prison into treatment, increased practice of doing so, and increased availability of comprehensive treatment (MAT again!) while in prison.
As Mayor Jim Kenney writes in a foreword, “a report cannot itself solve this crisis.” The next phase of work involves prioritizing and implementing these recommendations. In the coming month, Jeff Hom, MD, MPH, policy advisor in the Philadelphia Department of Public Health, will brief Penn’s Opioid Task Force and engage us in a conversation about the role researchers can play in achieving the objectives set forth in the report.