The magnitude of the opioid crisis offers unprecedented opportunity for healthcare and policy leaders to bring about lasting change to beat back overdose and expand access to medication treatments, a physician who has been instrumental in helping Rhode Island craft a response to the epidemic said at last week's Addiction Professional Summit in Warwick, R.I.
“We now have a lot of wind in our sails to make a lot of change,” said Josiah “Jody” Rich, MD, MPH, professor of medicine and epidemiology at Brown University's Warren Alpert Medical School. “This is our moment.”
In a small state that serves as a natural location for collaboration among leaders, Rich cited data that document how far the effort must go. An estimated 20,000 people in Rhode Island need treatment for opioid addiction, but at present the medication-assisted treatment that Rich says offers the best scientific evidence for reducing overdose encompasses only around 4,500 methadone treatment slots and around 70 active buprenorphine prescribers.
“That is woefully inadequate,” said Rich, who is also director of the Center for Prisoner Health and Human Rights at The Miriam Hospital in Providence. “We need to ramp that up quickly, as they did in Baltimore.”
The Nov. 5-6 summit, which was produced by the publishers of Addiction Professional and attracted an audience of professionals mainly from Northeast states hit hardest by the opioid crisis, took place against a backdrop of the much-publicized release of a Rhode Island governor's task force report of recommendations to reduce opioid overdose and addiction. Made public on Nov. 4, the report addresses prevention, overdose rescue, treatment, and recovery options, but clearly will require a great deal of political will to increase resources for response.
For example, the recommendations call for no wrong door to treatment, Rich said, with medication-assisted treatment made available at every location where opioid users may be encountered (medical practice, opioid treatment programs, criminal justice, etc.). Rich and colleagues at Brown offered much of the data analysis that shaped the task force report.
In addition, the task force is seeking a large-scale expansion of peer-based recovery coaching in the state. Cited on numerous occasions during the two-day event was an existing program in which peer outreach workers from the state's Anchor Recovery Community Centers visit hospital emergency rooms to engage overdose victims and link them to follow-up treatment and support services. Rich cited data showing that just under half of the individuals seen in a six-month period after the program's implementation were referred to treatment, compared with under 5% of individuals who had been referred in a pre-implementation period. The Anchor centers are a program of community behavioral health organization The Providence Center.
Rich also emphasized the need to continue to expand access to the overdose reversal drug naloxone. “There should be Narcan in every medicine cabinet,” he said, adding, “This is not a solution, but this is a critical component.”
Closing last week's conference was John J. Flynn, magistrate of the Rhode Island Adult Drug Court, which operates out of the state Superior Court. Flynn emphasized the cooperation among sectors of the justice system that is helping to redefine the state's approach to addressing nonviolent offenders with substance use issues. Accompanying him at the podium was a public defender.
“We have people who get along,” said Flynn. He pointed out that in drug court, attorney-client privilege is waived in order to facilitate collaboration on behalf of the offender.
Under the state's drug court program, a felony charge is dismissed (with records sealed) if an offender meets the terms of a contract with the court for 12 months. Notably, Flynn says all treatment options are available to offenders, including the medication treatments such as methadone that often aren't favored in state justice systems.
“I don't second-guess it,” Flynn said of the treatment matching that occurs. “The types of treatment, I leave to the professionals.”
Another two-day Addiction Professional Summit on opioid addiction and pain management will take place next June 23-24 in Pittsburgh.