Policy Solutions to the Opioid Crisis

Battling opioid addiction is a top policy priority throughout the United States and local and state policymakers and the federal government are focused on addressing the issue.  From a federal and state government perspective, solutions range from gathering data to define the problem to funding to border security to regulatory changes to empowering states and local governments to do more to address the issue.  State government leaders are also in the data gathering business but provide even more direct funding either from state or federal funds for local communities to address the issue.  Local communities are really where the action is when it comes to battling the opioid issue. Local governments, often through their county alcohol, drug and mental health boards, local private business leaders and for-profit and not-for-profit drug treatment providers are also in the mix.

Government and Private Sector Strategies to Address Opioid Challenge

Congress has been focused on addressing the Opioid Crisis for the past several years.  Their focus has been on spending and regulatory changes including a $650 M increase in funding for substance abuse and prevention and treatment programs, above the 2016 funding, and overall $6 B as well as reviewing other relevant issues such as the production and use of fentanyl, pill dumping and patient brokering.  In 2017, Congress passed two major initiatives including the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act. These provide critical resources for combating the crisis, including improving opioid treatment access, education for health care professions and risk education for athletes, research and treatment for women who are pregnant and facing addiction, treatment for newborns whose mothers are addicts. Also, Congress has incentivized non-opioid pain treatment and making it easier to locate and track federal grants, streamlined the Food and Drug Administration’s tools to intercept illicit drugs, ensured hospitals develop follow-up protocols for when patients are discharged following an opioid overdose; and work with states to improve the education, surveillance and treatment of injection drug-use associated infections.    There is no shortage of headlines about Washington’s efforts to address the illegal import of drugs through interdiction efforts such as building a wall between Mexico and the U.S. but so far that effort has failed.

State government efforts to address the Opioid Crisis have focused on reducing opioid prescribing, increasing the availability of naloxone, creating monitoring systems, and increasing funding dramatically for a new generation of treatment centers through public organizations such as county alcohol, drug and mental health boards.  The Kasich Administration has pointed to a $1 B program to address the Opioid Crisis in Ohio and the Ohio House Republicans have pointed to $180 M in program funding they added to the Kasich budget to address this issue primarily focused on expanding treatment options and funding.  Governor Kasich and the Ohio General Assembly have been working to address the Opioid Crisis through a range of budget and policy moves over the past several years.

Local communities, primarily through law enforcement, county alcohol, drug addiction and mental health boards, hospitals and private treatment centers are on the front lines to provide access to the life-saving naloxone, expand treatment options and aggressively combat the crime that is associated with the Opioid Crisis. Examples of local community engagement on addressing the Opioid Crisis includes.

• The Summit County Opiate Task Force uses local overdose rates and data from the Ohio Youth Risk Behavior Survey to inform strategic interventions. After the 2013 survey indicated one in six high-schoolers had used a prescription opioid medication without a prescription, and almost one in 20 had tried heroin, the Alcohol, Drug Addiction and Mental Health Services board invested in school-based and peer-led prevention activities. New treatment services, such as ambulatory detox, were added for youth addicted to opioids.
• Through community town hall meetings in churches and schools, a Wood County Opiate Task Force Facebook page and podcasts, family and friends of those addicted to opioids share stories, support and calls for action. To aid adults with addiction, a medication-assisted treatment program began within the courts; a new program began offering outpatient services for those waiting for residential treatment, the 211 Recovery Helpline Service was implemented, and both Bowling Green State University and Wood County Hospital hosted a lecture series for faculty and employees on the signs of addiction and the referral process for treatment.
• Hamilton County launched a regional effort supported four drug take-back events in the fall of 2016, bringing in over 600 lbs. of medications; implemented a patient survey (via pharmacy bags) when prescriptions are picked up; added drop boxes in private retail pharmacies; worked with real estate agents to provide personal lockboxes or locked cabinets in homes that were on the market tied to the Hamilton County Heroin Coalition strategic plan and is also part of a tri-state initiative: http://injecthope.com.
• Local pharmacies provide opioid prevention and harm reduction resources at their Stark County stores with Drug Free Stark County creating a five-point strategy card for responsible medication practice, a card that outlines steps to safeguard medications at home, and a bag designed to help community members collect and transport unwanted medications to drop off sites.
• The Franklin County Health Department partners with Southeast, Inc., a behavioral health treatment provider where the training and provision of naloxone takes place, and the City of Columbus, which co-developed an Opiate Community Resource Guide, and Southeast also collaborates with the Columbus Division of Fire on a Rapid Response Emergency Addiction and Crisis Team consisting of health professionals who respond with EMS on opioid overdose and mental health crisis situations to appropriately direct intervention.
• After a first responder has used naloxone to reverse the effects of opioid overdose for someone, the Lucas County Sheriff assists in identifying suppliers of the drug and follows up to help the person who overdosed enter treatment promptly, people who have survived overdoses are identified as “priority patients” and some enter treatment for addiction the day they are released from the hospital, and treatment resources have been increased through Medicaid expansion and levy funding to expand capacity in collaboration with providers.
• The Mental Health, Alcohol & Drug Addiction Recovery Board of Putnam County partnered with local leaders and employers to launch the Working Partners® Drug-Free Workforce Community Initiative, the objectives are to increase workforce readiness and employability; build healthier, more productive workplaces; and to create systems to educate employees – who are parents or have influence over young people – to prevent drug use among that population. Similar community initiatives are occurring in 18 other counties.
• In 2015, Ross County was awarded $100,000 by the Ohio Department of Public Safety’s Office of Criminal Justice Services to implement a comprehensive approach to combating the heroin overdose epidemic, the Heroin Partnership Project aims to increase public safety in communities throughout Ohio by developing effective community-based strategies that reduce the demand and supply for heroin and other opioid drugs, and the crosssystem collaboration involves law enforcement, treatment providers and prevention specialists.
• A Franklin County Heroin Overdose Prevention and Education Task Force coordinates law enforcement efforts to seize drugs tied to overdoses with the proactive linkage of overdose victims and their families to comprehensive preventive, treatment and recovery support services, and during one of the largest SHIELD Details, 26,000 doses of heroin were seized.

The battle against the Opioid Crisis is on-going and is truly a coordinated federal, state and local government partnership tied to local economic development and business leadership.