Opioid Epidemic Requires Integrated Strategies that Meet Local Needs
By Juan Luis Marquez
The opioid epidemic in America has raised alarm among public health practitioners across the nation. The multiple factors driving this epidemic have been well documented in both the popular press and academic literature including: deceitful marketing by pharmaceutical companies, increased focus on pain as a 5th vital sign by hospital and physicians, and high rates of poorly managed chronic pain. Additionally, there is increasing realization of the role of social isolation and childhood trauma (ACEs) in driving opioid use. Although this week there was an announcement by the secretary of the U.S. Department of Health and Human Services, Alex Azar, that the death rate of opioid overdoses was finally slowing down, as noted by Secretary Azar, “We are so far from the end of the epidemic, but we are perhaps, at the end of the beginning,” meaning that there remains a significant public health burden resulting from this epidemic.
No state is immune to the opioid epidemic, but its effects are not distributed equally across the country. The Midwest, Northeast, and Appalachia are some of the hardest hit regions with opioid overdose rates up to 250% the national average (CDC). There are significant efforts at the federal, state, and county level to combat this epidemic. Some evidence based strategies that have been employed include harm reduction (Naloxone distribution, syringe distribution ), increasing access to Medication Assisted Treatment (MAT), provider education, and policy changes (Good Samaritan Laws). One example of a county that is working to implement these strategies is Washtenaw County, Michigan, a state in the heart of the opioid epidemic. The Washtenaw Health Initiative, a coalition of organizations including the county health department, regional health systems, the sheriff department, and local treatment and recovery centers among others, is working to implement many of these strategies. Some strategies implemented by WHI partners include: 1) distribution of Naloxone to county law enforcement and training on how to use it; 2) naloxone distribution and training for community members; 3) syringe distribution by local organizations; and 4) improved efforts to provide treatment rather than punishment to those arrested for opioid related crimes. Most recently, an opioid summit was held to inform and engage the Washtenaw provider and resident community. Given the variability in community demographics, local resources, and local opioid use, it is critical for counties to be actively engaged in prevention and treatment efforts as there is currently no standard, “one size fits all,” approach that will work for all communities.
Juan Luis Marquez, a preventive medicine resident and Masters of Public Health student at the University of Michigan, is a 2018-19 Albert Schweitzer Fellow, Detroit chapter. His focus is on assessing the network of services for people and families with opioid addiction in Washtenaw County.