Tackling the Opioid Epidemic: Implications for Care Delivery

By Thomas Bauer | 31 Oct, 2016

Last week I posted a comment on the Opioid epidemic and its impact..... Join experts and the GHDonline communities beginning November 7 – 11, 2016 to discuss the implications of the opioid epidemic on care delivery.

The panel will discuss the drastic surge in the use of highly addictive prescription painkillers is devastating communities. In 2014, 28,000 Americans died from opioid-related overdose, and 2 million were misusing or dependent on opioids. In the midst of this opioid epidemic, health systems around the world are struggling to prevent opioid use disorder and overdose, as well as to manage the growing demand for treatment services.
The solutions to this complex epidemic will require collaboration among many stakeholders, including primary care providers, policymakers, and law enforcement.

During GHDonline’s week-long Expert Panel, our panelists will explore topics related to provider engagement in the prevention and treatment of opioid use disorder.

Stay tuned on updates and sign up for this Expert Panel discussion, November 7-11, by signing up on GHDonline and marking “Opioid Epidemic Expert Panel” under "How did you hear about GHDonline?" GHDonline members will be automatically added once the panel is live

If you have not experienced a GHDonline Panel discussion

1 A question is posted daily with the panel posting comments and resources to begin the conversation
2. The conversation will post (thread) similar to a chat
3. Check the site as your schedule allows daily to contribute and learn from the discussion. Each comment sparks answers and questions that lead to better understanding of the topic being discussed
4. Be prepared for the massive sharing of resources and expertise from our international community.
5. The panel discussion will be archived as a future resource.
If you have any questions regarding the panel or signing up for GHDonline, please reply to this posting

Attached resource:



Linda Anne L'Abbe Replied at 4:34 PM, 31 Oct 2016

Hello. I sit as a guest on the Mass Medical Society's Maternal and Perinatal Welfare Committee, and have done so for the last 15 years. This year we agree, for the Jewett Lecture, which is next week in Waltham, "Caring for Women with Opioid Use Disorder."
It is prevalent everywhere and no doubt lively conversations will continue next week with GHDonline.
I will share information after the Lecture. The speaker will be Dr. Sarah E. Wakeman.

Thank you
Linda Anne L'Abbe, CNM, MSN

Christina Congdon Moderator Replied at 1:54 PM, 3 Nov 2016

Thank you kindly for offering to share information from this committee lecture! This is a highly relevant topic, and I look forward to reading your posts.


Sandeep Saluja Replied at 8:20 PM, 3 Nov 2016

A very timely issue!I would also be keen to learn of non invasive neuromodulation to help treat such patients.Contrary to popular belief non invasive neuromodulation need not at all be expensive if academia steps in to produce low cost technologies.

brianne fitzgerald Replied at 8:44 AM, 4 Nov 2016

Another look at the opioid crisis

It is easy to blame and I would like to suggest rather than calling this an opioid crisis we are calling it a spiritual crisis, a spiritually and morally bankrupt society discerning into a hell of its own making. Drugs are powerful when our lives are broken. Maia Szalavitz says in her book Unbroken Brain “if you haven’t learned that a drug “fixes” you, you cannot be addicted to it”. It would seem that as a culture we have taken the easy way out, it is difficult if not impossible to tolerate being in in our own skin, the “dis” ease of feeling anything unpleasant. We rush to pharmacies, gurus, doctors, reality TV and our ever present cell phones to take us away from ourselves.
Our current treatment system for substance use disorders is far from perfect and most of it is in disarray. We throw whatever the latest and greatest idea is up against the wall and look to see if it will stick. Harm reduction is the new normal and although we support the expansion of HR projects (needle exchange, methadone, injectable naltrexone, Narcan and buprenorphine) we feel strongly that recovery and hope for an ordinary life has been forgotten.
The causes as well as the responses to addiction are the same. Family, community, peers, timing, choice all contribute to the path that is chosen. We as a community can do better to offer support and hope to those seeking wellness. Recovery skills are learned in the community by doing them. Short term residential treatment may set the stage, but there is little data to support that people are able to transfer skills acquired in an isolated setting back into their daily lives where they are most needed.
We advocate for sobriety and recovery. It is not easy, it is not boring, it is not only for alcoholics, it is not the norm. Society revolves around the getting and staying outside of one’s self. Sobriety is not just about giving up. It is about becoming in touch w who you are, forgiving, learning new coping mechanisms, learning how to deal with life on life’s terms, a complete transformation of body and soul. Education, a job, a reason to get out of bed in the morning can provide a strong foundation for getting well.
Sobriety is not for everyone, it is hard work and commitment and time, lots of time. Peace will come from being, not from having and our community norms and current cultural disarray might do well to consider this paraphrased 12 Step caveat, help yourself by helping others.

Elissa Dakers Replied at 11:50 AM, 4 Nov 2016

Thank you for your replies! We are excited to cover these topics and more next week, so I hope you'll join us then to contribute your comments.


Pamela Avila Replied at 7:18 PM, 7 Nov 2016

The problem with naloxone injections available to the general public is that the addict has to have this available at the moment of overdose. Most often, addicts are either in the company of other addicts, or alone somewhere when they overdose, and not necessarily near a clinic, fire station or other institution that might carry the medication. Perhaps it might be at their home, but no one else is there, or they are not at home when OD'ing. Many addicts are reluctant to call for help for fear of law enforcement response. I have personal experience in this regard, having lost my son to an overdose. His own twin brother did not call 911 when he overdosed for this very reason. He revived him doing CPR but then did not call for medical help. He died 3 weeks later, when he OD'd again, alone in a hotel room.

As a nurse practitioner and a parent, I have reacted to the opioid epidemic on a number of different levels. I feel extremely disappointed in our medical system, which compartmentalizes aspects of care. Young people do not necessarily allow their parents access to their medical records even though parents are likely those most motivated to help. In my son's case, the medicine department of a well know HMO was not in communication with the psychiatry or addiction medicine departments. My son received opiates, benzodiazepines, and Suboxone from all these different sources, and it was as if the clinicians never read each other's notes.

Rehabilitation programs do not impress upon the families of addicts the likelihood of relapse at the moment the addict leaves the facility. They do not inform patients and families of their increased vulnerability of ODing, due to the fact that addicts tend to use the same amount of opiates they are accustomed to, when they are likely to have much more sensitivity to high doses, having been abstinent for a period of time.
We knew none of this.

Our medical system allows too little time for providers to work with patients on alternatives to medication, motivational interviewing, stress management, and so on. Instead we are given impossible schedules, during which the only thing providers have time to do is write a prescription. Criminalization is the wrong approach. I am in complete agreement with Brianne Fitzgerald's commentary. This is a multifactorial problem which requires research, manpower, commitment and funding to fix.

Pierre Bush, PhD Replied at 10:40 PM, 7 Nov 2016

Dear Colleagues,
Thank you for this important panel. The national Academy of Science, engineering and medicine has convened an expert panel on Opioids, and the report is attached below.
It is very saddening to note that there are 100 million people in the USA who suffer from chronic pain. These people need help and the medications (opioids) must be managed properly so that the patients are not affected by the fear of overdose and abuse held by the society. The committee stressed the need for more research about the opioids use, and research of non-opioids analgesics. I personally concur with the committee. Something must be done in order to alleviate the suffering of these millions of people. At the same time we have to be aware of the side effects of opioids and work towards helping patients who are addicted to them without criminalizing/stigmatizing them.

Attached resources:

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