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Panelists of Tackling the Opioid Epidemic: Implications for Care Delivery and GHDonline staff

In the 1990s, pain was designated as the “fifth vital sign,” and physicians were urged to reduce pain with opioids. Pharmaceutical companies were also heavily marketing opioids to physicians. Since 1999, opioid prescriptions in the United States have more than quadrupled--despite no increases in reported pain.

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.

Current efforts to prevent opioid-related health problems include training physicians on safe opioid prescribing and alternative pain treatments to reduce opioid exposure, educating patients on the dangers of opioid misuse, increasing the availability of naloxone, utilizing prescription drug monitoring programs to identify individuals at high risk for overdose, and introducing state prescription drug laws.

In addition, health professionals must learn how to best treat individuals struggling with opioid use disorder. Medication-assisted treatments, such as methadone, buprenorphine, and naltrexone, are highly effective for treating opioid use disorder, but there are a limited number of physicians trained to provide these services. Systems connecting patients to long-term treatment are improving; however, there is still significant stigma surrounding addiction, hindering progress. Substance use disorders must be approached as a chronic disease, not as a moral failing. The solutions to this complex epidemic will require collaboration across multiple 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.

Our new Expert Panel format makes it easier to contribute to the wide variety of topics surrounding this issue. We look forward to hearing your thoughts across the discussion threads below!

What strategies are being implemented for overdose prevention & response?

Posted: 07 Nov, 2016   Recommendations: 3   Replies: 8

What does a “successful” overdose prevention and response program look like? Which strategies have been most successful or unsuccessful? What are some reasons for lack of success in rolling out and implementing these programs and policies? How do we get the treatment to individuals who need it most?

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What would the ideal treatment plan or system for opioid use disorder look like?

Posted: 07 Nov, 2016     Replies: 10

What is the best way to bridge patients to detox/long-term treatment? Who are the critical partners for providers when treating patients for opioid use disorder and what approaches might best engage them? What is needed to develop integrated systems?

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What alternatives are there for physicians to treat pain?

Posted: 07 Nov, 2016     Replies: 22

How can we incentivize doctors to change their prescribing patterns?

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What role does stigma and social determinates of health play in delivering/accessing opioid use disorder services?

Posted: 07 Nov, 2016   Recommendation: 1   Replies: 4

How do we combat stigma? How does stigma surrounding medication-assisted treatments (i.e., methadone and buprenorphine) hinder recovery?

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What cultural and socioeconomic forces are driving the epidemic?

Posted: 07 Nov, 2016   Recommendations: 3   Replies: 14

How can we educate patients (youth and adults) about the risks of opioids?

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How big is the opioid problem in the US?

Posted: 07 Nov, 2016     Replies: 2

On an average day in the U.S.

* More than 650,000 opioid prescriptions are dispensed
* 3,900 people initiate non-medical use of prescription opioids,
* 580 people initiate heroin use
* 78 people die from an opioid-related overdose

Economic Impact of the Opioid Epidemic:
* 55 billion in health and social costs related to prescription opioid abuse each year
* 20 billion in emergency department and inpatient care for opioid poisonings

Source US Department of Health and Human Services (2016)

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Unintended and neglected consequences of the opioid epidemic

Posted: 07 Nov, 2016   Recommendation: 1   Replies: 5

Any discussion of ways to address the current opioid epidemic must also focus some attention on solutions to ensure/increase access in LMICs.

Currently 150 countries don't have routine access to morphine and the vast majority of opiates are consumed by a minority of the world's population in HICs. To date, most effort has been put into preventing abuse with relatively little energy put toward increasing access in LMICs. Although simultaneously ensuring these two goals was the dual purpose of the UN Single Convention, in many ways it has failed. As we discuss ways to prevent abuse we must carefully evaluate if any solutions impact access to opiates to patients in LMICs and also actively discuss ways to improve pain care outside HICs.

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