There is no simple answer to the opioid epidemic. Drug overdoses have claim about 60,000 in 2016, which is the equivalent of roughly two 747 flights crashing every week. The president’s commission on combating the opioid epidemic is promising, but only if rhetoric is followed by action.
Yet, the current administration is returning to failed tactics from the past: a punitive approach to the war on drugs and a media blitzkrieg of “Just Say No” messaging — both contrary to the recommendations of the President’s commission and what we know from 40 years of failed drug war policies that have ravaged public health.
{mosads}After months of work, the president’s commission on combating the opioid epidemic released their recommendations, “The first and most urgent recommendation of this Commission is direct and completely within your control. Declare a national emergency.”
However, instead declaring a national emergency the president dubbed this a public health emergency, which does not entail allocation of additional funds that are badly needed to combat this epidemic.
What might we have invested in if the president had deigned to designate this a true crisis and allocate funding? One low-threshold change that would make a world of difference would be to adequately fund care coordinators to work with people with substance use disorder to help them navigate the often complex universe of treatment and health care. This relatively small but vitally important service could make a world of difference in bolstering our response to the opioid crisis and saving lives.
As an addiction medicine expert, I treat individuals with substance use disorders, including those who grapple with opioid use. In addition to their struggles with addiction, they face a wide range of challenges, including but not limited to: mental health challenges, financial instability, housing insecurity, unemployment, legal issues, transportation access, strains on relationships, and hunger.
Relatively few people have the opportunity to understand the ins and outs of the medical system as well as I do as a physician interested in health policy. Yet, when it comes to navigating my personal health care, I often face roadblocks, frustration, and a loss of several hours of my time.
I can only imagine what my patients, with all of their complexities, go through. Unfortunately, but predictably, this often leads to patients “slipping through the cracks” and being labeled “non-compliant” when in fact it is the medical system that has failed them.
What we need are care coordinators to help our family, friends, and neighbors struggling with addiction to navigate the comprehensive care that addiction requires. This position doesn’t require a specific degree, just passion and compassion.
Without care coordinators, existing staff must attempt to juggle these complexities in addition to their extensive responsibilities. Unfortunately, all too often this results in doctors pulling their hair out as they try to secure prior authorization for medications, obtain medical equipment, referrals, or figure out our patients’ insurance status. This approach is inefficient and wasteful.
When I’m in this position, I get frustrated, I feel an even greater time pressure, and I loathe the fact that my clinical time continues to dwindle. Does it make sense for me to use my time sitting on hold or actually providing patients with clinical care?
On the other hand, as we’ve seen when de facto care coordinators work with people who participate in well-funded clinical trials, they swiftly learn and master the tricks of the trade, forming connections with stakeholders and effectively communicating necessary information.
They form relations with patients and often serve as their trusted go-to. When the patients finish the clinical trial, we often offer continued care in our clinic. Guess who accompanies them to their appointments?
Who navigates picking up medications and ensures follow up? And even holds them accountable and encourages behavioral shifts when they are not holding up their end? That’s right — our research funded de-facto care coordinators.
Patients who participate in these studies have an extra advocate in their corner, one with many crucial connections — and the benefit is clear. Although these patients face some of the most severe addictions and complicated social issues, they often respond incredibly well given the extra aid.
My patients without this added support sometimes struggle to follow my recommendations for prescriptions or follow up; for those who are working with a care coordinator, I feel confident that they will get the medications or follow up appointments I recommend.
So why wouldn’t we include care coordinator positions — providing better care for the patients and freeing up more clinical time for the doctors — every time we open a new addiction clinic? Simple: it’s all about the money.
Can we optimize treatment in a more cost efficient way? Yes. Should we? Of course. Implementation and cost effectiveness are two fields that we must invest in heavily if we are to curb the rising costs of medical care (a would-be benefit of a single payer system), and decrease overdose deaths. But this is all the more critical amid an emergency, when we need swift action and funding that will save lives and possibly money in the long run.
Mr. President, what we need — and what you promised — is for you to act on your commission’s recommendations and declare a national emergency. Show us the money. People’s lives depend on it. Our communities depend on it.
Daniel Schatz, M.D. is an addiction medicine fellow with NYU in the Department of Population Health. Schatz’s clinical work is at Bellevue Hospital in New York City and is a collaborator with the Drug Policy Alliance.