Work together

Communities are often resource rich and coordination poor. Resources—financial, human, programmatic—are precious, and given the extent of this crisis, we cannot waste them. Unlikely collaborators must learn to work together, communicate continuously, and think beyond the perceived boundaries of their role in the community. Well-intentioned providers need to work together across areas, which likely means moving beyond the borders of their institutions and traditional roles to create new relationships and pathways in order to provide coordinated services to those in need.

Work on multiple parts of the system simultaneously

Many efforts focus only on one part of the crisis. We cannot focus just on prescribing guidelines, just on naloxone distribution, just on increasing access to treatment, just on preventing diversion. We need to focus on them all, and all at once, because a multi-faceted problem requires a multi-faceted solution. Think of the response to a natural disaster: we don’t focus only on housing, or food, or infrastructure – all pieces need to come together. The same is true of the opioid crisis; preventing a fatal overdose through the administration of naloxone is important, but addressing the ongoing addiction requires a system approach.

Be unambiguous about the risks of prescription opioids

Let’s be clear: approximately 75 percent of heroin users started on the road to addiction with prescription drugs. Let’s change the conversation with patients from a footnote that prescription opioids can be dangerous if abused, to a frank discussion about how prescription opioids and heroin affect the brain and body in the same way.

Let’s tell patients and their family members that the majority of people who become addicted to prescription opioids were not engaged in drug-seeking behavior or recreational use, and were simply taking a medication to relieve pain as prescribed by their physician. Let’s use opioids when they are the only option or for palliative or cancer care. Let’s be appropriately afraid of prescription opioids and treat them like the lethal drug they can be.

Re-train the medical community

Physicians received misinformation about the risks and benefits of prescription opioids for treating chronic pain, and we know that changing practice takes time. However, we do not have the benefit of time with 44 individuals dying each day. Prescription guidelines are important, but physicians need to be re-trained in how they treat patients with all kinds of pain. There are effective alternatives for chronic pain management; providers need to use them and payers need to adequately reimburse for them.

Recognize that addiction is a chronic disease, and treat it accordingly

The people who are addicted and dying in this opioid crisis cross all boundaries. They include high school athletes, middle-aged women, and high-functioning executives. They are individuals, not some amorphous group beyond help. Indeed, addiction in any form is not a moral failing; it is a physical and psychological disease that must be managed over time like any other chronic disease. Recovery from addiction is long and painful, and the stigma around addiction only prevents people from getting the help they need.

The statistics are staggering: in 2014, 28,647 individuals died from a drug overdose involving some type of opioid, a 14 percent increase from 2013, already the highest year on record. But we can’t let them overwhelm us. For the parents who just buried their daughter who became addicted to opioids after a sports injury, the baby born dependent on opioids, or the suburban mother accidentally overdosing when she became addicted to prescription painkillers after a car accident, the statistics are irrelevant. But even though their pain is singular, working in isolation cannot be the solution; states and communities need to provide the infrastructure for success.