Keynote: Combating the Opioid Epidemic

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“This is something that wakes me up at night. How do you look into the data and accept that where we are is no better than where we’ve been?”

– RADM Trent-Adams

While some states have made great progress in reducing overall drug overdose deaths, certain regions of the country (including the West and Northeast) are still experiencing trends in the opposite direction. And while deaths from heroin, natural and semi-synthetic opioids, and methadone are trending downward, the country is seeing a resurgence in deaths from synthetic opioids (such as fentanyl), cocaine, and psychostimulants, a category which includes methamphetamines.

These were some of the big-picture trends that Rear Admiral Sylvia Trent-Adams, PhD, RN, FAAN, Principal Deputy Assistant Secretary for Health in the U.S. Department of Health and Human services, presented in her opening keynote address at the summit, which focused on the current state of opioid misuse and deaths in the United States and the federal response to it.

In the past year, of the 11.4 million people who misused opioids, 53% of them obtained them from a friend or relative, while only 36% acquired them from a health care provider’s prescription, Trent-Adams stated.

And while since January 2017 overall opioid prescribing in the U.S. is down 34%, prescriptions for the overdose-reversing medication naloxone are up 344%, and the percentage of patients receiving medication-assisted treatment (MAT) is up as well, continuing to increase the availability of opioid use disorder treatment – particularly by expanding capacity within rural communities, and ensuring real-time access within urban communities – is something that’s still desperately needed, she said.

“Addiction needs to be treated as a chronic disease, not a moral failing,” she said.

She outlined the HHS 5-point strategy to focus on the opioid epidemic: better addiction prevention, treatment, and recovery services; better data; better pain management; better targeting of opioid overdose-reversing drugs; and better research.

U.S. Department of Health and Human Services Initiatives to Combat the Opioid Epidemic

“Every sector of every community needs to be engaged,” Trent-Adams said, describing the HEALing Communities Study (part of the larger Helping End Addiction Long-term Initiative) as one example of a “whole society approach” to test integrated, evidence-based interventions across healthcare, behavioral health, justice, and other community-based settings. “No single policy is going to be large enough or significant enough to significantly reduce addiction-related deaths,” she said.

Trent-Adams also outlined some of the department’s other related priorities within substance use prevention, including directly addressing the resurgence in methamphetamines and cocaine, implementing the SUPPORT Act, and “transitioning from a crisis framework into an integrated, sustainable, predictable and resilient public health system that will address preventing substance use and other behavioral health issues concurrently.”

“We need to align reimbursement so that people can get paid for the right therapy at the right time,” Trent-Adams stated, and described two forthcoming opioid alternative payment models.

Other specific HHS policy priorities include enhancing Emergency Room MAT treatment and warm handoffs following overdose, and improving MAT during transitions into, and out of, the criminal justice system.

“Only by working together can we meet at the precipice of this crisis, and work together to lay the foundation for a healthier country ahead,” Trent-Adams urged. “Please, remain focused and work with us.”