How Government Actions Can Help Address the National Opioid Epidemic

The Surgeon General released a report, “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health” last December.  The report focuses on a variety of communities, including Veterans, as it discusses how government can work with the private and non-profit sectors to best address the growing addiction problem and the significant challenges posed by implementing effective, long term treatment.  Lessons can be learned from advances in management of programs to treat alcohol and substance use and abuse disorders alongside general healthcare diagnosis and treatment.  

Fortunately, federal agencies, state and local governments, private sector companies, and non-profit organizations are partnering to tackle the issue. For example:

At the Federal level:

• the Department of Defense’s (DoD) Pharmacy Data Transaction Service automatically screens all new medication orders against a patient’s computerized medication history and permits DoD physicians to monitor for concerning drug usage patterns.

• the Department of Veteran Affairs (VA) supports the Opioid Overdose Education and Naloxone distribution program to help Veterans at risk of an opioid overdose. 

At the state and local level:

• federal agencies such as the Department of Health and Human Services (HHS) are expanding state-level prescription drug overdose prevention strategies, increasing the availability of medication-assisted treatment programs, and improving access to the overdose-reversal drug naloxone. 

• The Centers for Disease Control and Prevention (CDC) launched a $20 million Prescription Drug Overdose: Prevention for States initiative in 16 states to expand their capacity to put prevention into action in communities nationwide and encourage education of providers and patients about the risk of prescription drug overdose.

For Veterans, there are a variety of programs in place at the federal, state, and local level, some of which are outlined in  the Surgeon General’s report.  Highlights include:

• “A large study examined improvement in substance use outcomes among 12,270 veterans who were diagnosed with PTSD and a substance use disorder and treated in specialized intensive Veterans’ treatment programs. The study found that treatment in longer-term programs, with prescribed psychiatric medication and planned participation in program reunions for post-discharge support, were all associated with improved outcomes.”

• “Reductions in substance use were also associated with improvements in PTSD symptoms […]. The findings suggested that intensive treatment combined with proper discharge planning for veterans with severe PTSD and a substance use disorder may result in better outcomes than traditional substance use disorder treatment. A study among homeless Veterans with a diagnosis of a substance use disorder as well as a mental disorder found that those who took part in a low-intensity wrap-around intervention showed improvements in a number of substance use, mental health, and behavioral health outcomes from the beginning of the study to follow-up 12 months later.”

• “Recovery coaching has the potential to become an important part of [Recovery Support Services] and the recovery process. A descriptive study of 56 recently homeless Veterans with substance use disorder suggested that supplementing psychotherapy with recovery coaching increased length of abstinence at follow-up 6 months later.”

Other efforts dedicated to helping Veterans include:

• The Centers for Disease Control and Prevention (CDC), in March of 2016, created guidelines and a web resource to improve “the way opioids are prescribed through clinical practice guidelines [to] ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.” The website enables patients to understand opioids, how as many as 1 in 4 people receiving prescription opioids struggle with addiction, and provides non-opioid options along with additional resources.  For health care providers, the website links to Guidelines for Prescribing Opioids for Chronic Pain, including dosage recommendations and highlights a training series to better understand the changes.   The site includes a mobile app link as well as brochures, fact sheets, and checklists all aimed to help educate patients and providers quickly.
• The Department of Veterans Affairs created “Housing First,” an “evidence-based, cost-effective approach to ending homelessness for the most vulnerable and chronically homeless individuals. The Housing First model prioritizes housing and then assists the Veteran with access to healthcare and other supports that promote stable housing and improved quality of life.” There is a strong correlation between homelessness and substance abuse disorders.  This approach will address the half million Veterans who suffer from addiction. Other evidence based components of successful treatment include methadone, buprenorphine, naloxone to reverse the effects of overdose and behavioral health treatment and are being employed to treat veterans with some success.  Since 2013, the Veterans Health Administration (VHA) has seen a:

                              22% reduction in opioid use

                              42% reduction in use of opioids and benzodiazepines

                              32% reduction in dosages 

• Additionally, VHA and Kaiser Permanente have successfully implemented primary care-based programs in a sustainable manner. They have used techniques such as:

1. Integrating screening, assessment, and clinical decision support tools in the Electronic Health Record system;
2. Establishing interdisciplinary (primary care, substance use disorder treatment, and mental health) teams to guide integration and collaboration;
3. Encouraging health system leadership support; and
4. Using training curricula, targeted communications materials, robust performance feedback reporting for physicians and other staff, and existing financial incentives.

The Surgeon General’s report brings a spotlight on this sensitive issue, and provides some positive examples of how government is responding. Other agencies are using education, partnerships, and pilot programs to help identify and implement paths to recovery for Veterans and their families.

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