Commentary: What Foundations Can Do to Fight the Opiate Epidemic
Foundations can play a vital role in battling the epidemic of opiate overdoses. Prescription drug abuse is the fastest growing drug problem in the United States, while heroin use is also on the rise in communities around the country. In addition to funding, some foundations have the expertise to provide technical assistance and can bring together communities and policymakers to devise solutions to this devastating public health problem.
According to the Centers for Disease Control and Prevention, the increase in unintentional drug overdose death rates in recent years has been driven by increased use of opioid analgesics. Since 2003, more overdose deaths have involved opioid analgesics than heroin and cocaine combined. For every unintentional overdose death related to an opioid analgesic, nine persons are admitted for substance abuse treatment, 35 visit emergency departments, 161 report drug abuse or dependence, and 461 report nonmedical uses of opioid analgesics.
One of the major roles foundations can play in the opiate epidemic is to support grassroots prevention efforts. We can fund drug take-back programs, providing money for disposal units for hospitals and police stations and anywhere else communities feel they need such units. We can also sponsor education for patients about what do with unused medicines.
We can encourage prescribers to use their state’s prescription monitoring program, which are designed to prevent “doctor shopping” for opiates. These databases are used to monitor the prescription and disbursement of prescription drugs designated as controlled substance by the Drug Enforcement Administration. The program allows physicians and pharmacists to log each filled prescription into a state database to help medical professionals prevent abusers from obtaining prescriptions from multiple doctors.
In addition, we can promote screening, brief intervention and referral to treatment (SBIRT) programs. While basic SBIRT services may be funded by insurance, foundations can provide technical assistance, by educating physicians, medical staff and counselors about how to work together to implement these programs in a medical practice or a hospital.
Needle exchange programs are another area where foundations can have a large impact on opiate abuse. These programs are a powerful, yet relatively inexpensive, way to reduce harm from injection drug use. One of the most common health consequences of injection drug use is endocarditis, or inflammation of the inner lining of the heart chambers. One heart valve replacement costs at least $250,000, while an entire needle exchange program generally costs between $50,000 and $60,000 per year.
Foundations can also advocate for the wider use of naloxone (Narcan). Naloxone is carried by ambulances to reverse overdoses. It saves lives. In some states it is available to be administered by trained members of the general public who might be present when an overdose occurs. We can fund community-based distribution programs and the advocacy and education efforts needed to change laws so that naloxone is more widely available.
In addition to backing new initiatives, foundations can foster effective implementation of laws such as the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). This federal law requires insurance companies to treat mental illness and substance use disorders no differently than other medical conditions. The law applies to employer-sponsored health plans with 50 or more employees and Medicaid managed care plans.
Under the law, plans are not mandated to offer addiction and mental health benefits, but if they offer such benefits, they must do so in a non-discriminatory manner. That means a plan must have the same co-pays, deductibles and annual and lifetime caps on medical/surgical benefits and mental health/addiction benefits covered by the plan. We can fund monitoring, public education and evaluation efforts to make sure this act is implemented in our states.
Finally, foundations are in a perfect position to assist existing treatment programs in implementing evidence-based treatment practices and to build their capacity. Many programs are interested in adding medication-assisted therapies to their current programs but do not have the processes, policies, or staff to do this work. Foundations can provide the needed start-up funds and sustainability technical assistance that these agencies need to embrace new practices and more clients.
With everyone focused on the economy, foundations have a powerful argument for focusing on substance use disorders. If we can prevent and treat substance use disorders, we help can get extraordinarily high substance-abuse related costs in the criminal justice, medical and foster care systems under control. Foundations cannot supplant government funding for these programs, but we can help our communities figure out the smartest ways to address these problems. We can bring issues into sharper focus and help our communities find new and different ways to fight the opiate abuse epidemic.
Ann Barnum is Senior Program Officer, Substance Use Disorders at The Health Foundation of Greater Cincinnati. She works with organizations throughout the Foundation’s 20-county service area to develop innovative programs that deal with substance use disorders.