Collaboration, Naloxone Access Key to Curbing US OD Crisis

The Permanente Federation

Community, government and health care partnerships play a key role in addressing opioid-related overdoses, said a panel of experts who recently convened to discuss the fentanyl crisis in the United States. The panel, which included physicians and first responders as well as academic, government and community leaders, also agreed that naloxone, a life-saving medication that can reverse opioid overdose, should be made more readily available in communities. The experts’ suggestions are documented in the article “Strategies to Reduce Harm: An Expert Panel Discussion on the Fentanyl Crisis,” published by The Permanente Journal on January 24, 2023.

More than 81,000 lives were lost due to opioid-related overdoses in the United States during the 12-month period ending in July 2022, according to provisional data from the Centers for Disease Control and Prevention. The panel was convened to highlight the crisis and advance understanding and strategies to prevent further loss of life. The panelists noted that while instances of substance use have remained relatively stable, overdoses have increased dramatically, highlighting the need for new and better treatment options.

“The increasing potency coupled with an unpredictable environment is contributing to the rise in morbidity and, in particular, mortality,” said Christopher M. Jones, PharmD, acting director of the CDC’s National Center for Injury Prevention and Control. “I think naloxone should be readily available in communities. I think we can be empirical to some extent and data-driven in how we think about where we deploy it.”

Other panelists included Sarah Bagley, MD, of Boston Medical Center; Amy Jo Cook, EMT-P, firefighter and paramedic from Portland, Oregon; David Lawrence, MD, of David Geffen School of Medicine at University of California, Los Angeles; Sarah J. Leitz, MD, Department of Addiction Medicine, Northwest Permanente; and Pam Pearce, CRM, executive director of Community Living Above, West Linn, Oregon.

The panel agreed that the continued proliferation of highly potent, unpredictable drugs makes it increasingly difficult for users to understand what they are taking. Fentanyl pills are often made to look like more familiar prescription medications, adding to their misuse.

Panelists said access to methadone remains a significant problem, and the inadequacy of resources and infrastructure for treatment is common. They emphasized the importance of fast-tracking the development of vaccines related to blocking the effects of fentanyl, given the public health emergency for opioid-related overdoses. Some experts also maintained the need for better access to injection and safe smoking supplies and overdose prevention sites.

“New York City is now leading the way in the U.S. on overdose prevention sites, demonstrating how many deaths can be prevented if there’s a safe place for people to go to use, but unfortunately, these remain illegal at the federal level despite decades of great evidence from across the world demonstrating their efficacy,” Dr. Lawrence said.

It has become easier for illicit drug manufacturers based in China, India, Afghanistan and Mexico to make money producing synthetic opioids. The demand for opioids increased as prescription regulations tightened, shortening the supply of pills for misuse, presenting an opportunity for fentanyl producers.

“When we instituted policies to limit prescribing opioids, we were successful in reducing prescriptions, but not harm,” Dr. Lawrence said. “Although the fire may have been lit by opioid prescriptions, we did not put that fire out with the policies that were later implemented, and in fact the problem has only become worse now than we’ve ever seen it before.”

Cook, the firefighter and paramedic, underscored the important role of the media in educating the public about the opioid crisis and available treatment options.

“I think the media push to make sure that buprenorphine is an everyday word and that the availability of medically assisted treatment options for people becomes normalized is important,” Cook said.

Panelists agreed that in addition to fostering public awareness of the crisis and potential options, physicians and clinicians need greater education. They also agreed that schools, faith-based institutions, justice systems, social services, harm reduction and health services, need to work together to address the issue in each community, including the reduction of stigma around people who use drugs and their treatment in society.

In addition, panelists agreed that there should be more focus on thinking creatively about how to get the life-saving opioid-reversal medicine naloxone into communities. It was suggested that this would create opportunities for increased community engagement in addressing the issue and that communities should be empowered to identify sites for naloxone distribution.

The paper “Strategies to Reduce Harm: An Expert Panel Discussion on the Fentanyl Crisis” that documents the discussion is available open access.

About The Permanente Journal

The Permanente Journal, published by The Permanente Federation, is a premier publication for content related to health care delivery science, value-based and high-value care, and clinical and applied research. An open-access publication, The Permanente Journal has been publishing research on the practices of high-quality, evidence-based, equitable, and value-based and high-value care since 1997.

About The Permanente Federation

The Permanente Federation LLC is the national leadership and consulting organization for the 8 Permanente Medical Groups, which, together with the Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, comprise Kaiser Permanente. The Federation works on behalf of the Permanente Medical Groups to optimize care delivery and spread Permanente Medicine — medicine that is person- and family-centered, compassionate, evidence-based, technology-enabled, culturally responsive, team-delivered, and physician-led. The Federation, based in Oakland, California, fosters an open learning environment and accelerates research, innovation, and performance improvements across the Permanente Medical Groups to expand the reach of Kaiser Permanente’s integrated care delivery model and to lead the nation in transforming health care.

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