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    Policy Approaches to the Opioid Crisis

    11/8/2017

    From left to right: Sir Angus Deaton, Bertha Madras, Rebecca Haffajee, Jason Doctor, Alan Weil, Leonard D. Schaeffer

    Policies that are multifaceted with a complex implementation are required to put a dent in the opioid epidemic wreaking havoc nationwide. This is according to an expert panel convened by the USC-Brookings Schaeffer Initiative for Health Policy in Washington, DC, on November 3.

    “There is no easy solution to any of this,” said Sir Angus Deaton, a Nobel laureate and USC Presidential Professor, during his keynote remarks. He noted how the trends in opioid overdoses intersect with issues of healthcare, economic policy, education, and overall changes in society.

    Representative Ann McClane Kuster (D-NH) and Harvard Professor Bertha Madras also gave keynote presentations to an audience of over 135 policy makers, journalists, researchers, and community members.

    The opioid epidemic has reached unprecedented levels with one thousand Americans treated in emergency departments for improper use of prescription opioids daily. Ninety-one Americans die every day from an opioid overdose. The trajectory of overdose deaths has increased so rapidly in the last couple decades that drug overdoses are now the leading cause of death among Americans under the age of 50.

    “The complexity of this crisis is well beyond the capacity of any one state or any one community,” said Representative Kuster in her opening remarks, noting the crisis doesn’t pick political parties. “We need a nationally coordinated response.” Kuster is a founding member of a 100-member congressional task force that meets regularly to discuss policy solutions to the opioid crisis. Last year the task force pushed the passage of 18 bills in one week which together became the Comprehensive Addiction and Recovery Act.

    “We need to make sure that we have not only the policy but the resources behind it to actually make a difference,” said Representative Kuster.

    Last week the President’s commission on opioids published a report detailing recommendations. Professor Bertha Madras, who co-authored the report, outlined the root causes of the opioid epidemic, who should bear responsibility, and the 65 recommendations the commission made.

    Societal Change and Deaths of Despair


    Putting the epidemic in the broader context of mortality and morbidity trends, Professor Deaton presented his findings that show the downward trend for all-cause mortality for US whites aged 45-54 since the start of the 20th century has stagnated or reversed in the past 15 years. On the other hand, during the same timeframe, all-cause mortality among counterparts in European nations have continued to decline. 

    He noted that the three most rapidly rising causes of death since the turn of the century are accidental deaths, suicides, and alcohol-related liver mortality. When dissected by education the pattern is even more dire with those without a four-year college degree ranking as the most affected group.

    He pointed to changes in the economic and labor landscapes as drivers of these deaths of despair: “We need better economic policies for ordinary Americans. We need to be able to share and not just let it all go to the top,” said Deaton.

    Policy Solutions to the Crisis are Difficult to Implement



    Professor Bertha Madras pointed to generational forgetting and poor science in terms of prescribing and awareness about the addictive potential of opioids, coupled with external factors as root causes.

    “Mandating training does not necessarily lead to practice change. There has to be far more intricate and finely tuned measures to insure over prescribing does not continue,” she said. 

    Professor Jason Doctor agreed. “Clinicians are good at learning clinical facts but to be an expert at decision making is an entirely different thing,” he said during the expert panel. Doctor holds the Norman Topping Chair in Medicine and Public Policy at the USC Price School of Public Policy. He pointed to a breakdown in prescribing practice and suggested part of the answer might be in bringing data pieces together so doctors can see the effects of their prescribing more clearly.

    Getting physicians to change is difficult, said Madras. She pointed to strong consensus with regard to increasing access to treatment, increasing access to rescue, and increasing health insurers’ responsibility in allowable prescribing and accessing treatment options.

    Panelist Rebecca Haffajee, assistant professor in the School of Public Health at the University of Michigan, agreed that the immediate acute need is increased access to medication treatment strategies and medication assisted therapies.

    The panel discussion covered a range of topics from payment to efficacy of treatment strategy to the need to involve diverse stakeholders from public health, law enforcement, and healthcare.  All the panelists agreed the solution hinged on adequate resources and support to communities and families affected.

    “We can’t arrest our way out of this crisis,” Deaton said.  

    Video of the event is available here