The Opioid Epidemic: A Multi-Stakeholder Problem Requiring a Global Solution
When healthcare enthusiasts like myself think about how to disrupt healthcare, we tend to think about problems that we see in our daily life or in our backyard. However, there are a lot of challenges globally with how healthcare is delivered. This blog will discuss some of the solutions that we could begin to implement in order to address one of the biggest global health challenges today - opioid misuse - before it becomes an even bigger global health epidemic.
WHO estimated 36 million people used opioids in 2016, of which 27 million people were affected by opioid use disorders in 2016 and roughly 450,000 deaths in 2015. [1] “In the late 1990s, pharmaceutical companies reassured the medical community that patients would not be addicted to opioid pain relievers” and so prescription rates increased significantly. [2] Instead of seeing increased quality of care though, the HHS had to declare a public health emergency in 2017.
Many healthcare specialists are thinking through whether opioid addiction can be solved with better prevention or lower prescription rates. For example, Dr. David Kalainov, MD, EMBA’19, an orthopedic surgeon at Northwestern Memorial Hospital, has worked to reduce the number of opioid pills prescribed postoperatively by instituting a cross-departmental electronic health record tool to prompt doctors to consider a multimodal pain treatment approach. [3] However, there are many other challenges that need to be addressed, including treatment accessibility. Naloxone is the main treatment that is utilized for narcotics overdose in an emergency setting so one would assume this drug should readily available. However, less than 10% who need them are receiving it due to the challenges with accessibility. [4] With increased marketing of opioids, the crisis is continually becoming a global issue with no solutions. In developing regions, such as India and West Africa, addiction rates and death rates have surged due to a weaker and, hence, less regulated synthetic opioid, tramadol [5, 6, 7]. In developed regions, similar trends are occurring; for example, Australia has doubled their opioid deaths in just a decade [8]. Therefore, we need to find solutions fast.
Although the opioid crisis is clearly an international issue, Americans are more likely to die than people in other countries. [9] A majority of this is due to other countries’ efforts to make Naloxone more accessible compared to America. When researching the opioid epidemic, the conversation is also now becoming more of a societal problem rather than a healthcare problem. Barry Quart, CEO and President of Heron Therapeutics, stated it best: “To date, most healthcare stakeholders have understood and reacted to the opioid crisis primarily as a societal problem. This reaction is understandable, given the size and scope of the crisis. But what makes this crisis unique to other health and drug epidemics is that it affects individuals regardless of socio-economic status, race, culture, or education.” In order for us to make progress on addressing this epidemic, we must give authority to the right stakeholders and currently, we are under appreciating the role government could play in combating the national and global crisis. Rwanda’s government has found promise by overseeing domestic, small scale production of morphine assuming primary control of the distribution. [10] We need to shift the viewpoint from treatment to prevention as we have done with other healthcare issues like cardiac issues and end-stage renal disease (ESRD). By looking at what has worked in the past for other global health issues, we have researched and compiled some solution ideas below:
Early Identification of High Risk Opioid Misuse: Companies like Cricket Health have utilized payor data of patients to analyze patients at risk of certain diseases such as ESRD. Similarly, companies are creating risk scores based on data to help with population health and management of health risks. [11] A similar approach can be done to identify patients who are at high-risk of opioid misuse based on not only patient health records, but also social determinants of health.
Educational Programs: A large barrier to solving global health issues is understanding the core pain points. Therefore, the government or organizations can help by developing, funding, and implementing education programs. This can help reduce the stigma of opioid addiction as well as educate consumers on treatment options. [12] Moreover, this can reduce demand for Naloxone and enable increased access to treatment for patients who overdose.
Accessibility to Naloxone: Addressing the accessibility of Naloxone to treat current patients can help reduce deaths in the short-term as we build out preventive solutions that are scalable and reduce reliability on opioids. There are several examples of this in global health - for instance, increasing the access and affordability of a highly-effective drug for Hepatitis C patients has become an important issue that Medicaid doctors and manufacturers have come together to focus on [13].
Adopting Preventive Viewpoints: Long-term, increasing access to Naloxone is not the only solution needed. Therefore, adopting a preventive viewpoint to healthcare will be crucial. Because increased surgical procedures are leading to increased opioid misuse, providers and payers should align incentives to encourage more preventive care services to reduce the need for surgical procedures when not absolutely necessary. The government can play an important role in shaping initiatives to push for a more preventive view; for example, HHS launched a presidential effort to expand treatment options, reduce the number of citizens who require treatment, and reduce costs for patients suffering from kidney disease [14].
Invest in Research: Currently, our healthcare delivery system is set up to have a high reliability on opioid usage as a form of pain management. We can shift the incentives away from opioids by investing in research to develop non-addictive pain treatments.
As substance use disorders is beyond opioid misuse, solutions that we discussed in this blog for opioid abuse can be leveraged to address additional substance abuse disorders, including but not limited to, alcohol, cannabis, and cocaine [15]. As we think about disrupting healthcare, we should think strongly about how to put measures in place to avoid future epidemics.
Thank you so much for your time reading and feel free to reach out to us if you have any questions. We look forward to seeing you at Kellogg’s Business of Healthcare Conference if you have tickets to our sold out, 20th annual conference!
About the Author:
Malvi Hemani
Malvi is a first-year MBA + MS in Design Innovation student at Northwestern’s Kellogg School of Management and McCormick School of Engineering. At Northwestern, Malvi serves as a board member of a local nonprofit, MBA Admissions Interviewer and Director of Kellogg’s 20th Business of Healthcare Conference. In addition, Malvi is a Strategy and Operations intern part-time at a Chicago-based oncology precision medicine startup.
Prior to Northwestern, Malvi worked at Deloitte Consulting where she assisted federal health agencies identify operational cost efficiencies and recommend technology investment strategies. Her most recent role was focused on managing the growth strategy for an open-source, data analytics product that was used by several healthcare organizations. Her expertise lies in connecting public and private data sources together in order to develop scalable strategies.
Her passion for healthcare started at Johns Hopkins University where she designed and developed two global health medical devices focused on maternal and neonatal health. She organized clinical trials for the products post-graduation, presenting findings at conferences and publishing in scientific papers. She graduated from Johns Hopkins University with a BS in Biomedical Engineering and Minor in Computer Science.
SOURCES:
[1] https://www.who.int/substance_abuse/information-sheet/en/
[2] https://www.hhs.gov/opioids/about-the-epidemic/index.html
[3] https://physicianforum.nm.org/orthopaedic-surgeon-leads-opioid-dosing-guidelines-for-nm.html
[4] https://www.who.int/substance_abuse/information-sheet/en/
[6] https://www.theguardian.com/world/2019/aug/28/india-opioids-addiction-us-drugmakers-push-painkillers
[7] https://www.healthpovertyaction.org/wp-content/uploads/2019/02/India-opioid-crisis-briefing-WEB.pdf
[9] https://www.globalhealthnow.org/2019-10/italys-take-home-message-us
[10] https://apnews.com/4fb083a770cb916348943a2966579bc7
[11] https://healthitanalytics.com/news/10-high-value-use-cases-for-predictive-analytics-in-healthcare
[15] The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016