On Opioids, We Found a Consensus Among Hoosier Experts: It's Time to Act

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(Images courtesy of Indiana University.) From left-to-right: Nicolas Terry, Ross Silverman, Aila Hoss. (Images courtesy of Indiana University.) From left-to-right: Nicolas Terry, Ross Silverman, Aila Hoss.

The scale of the opioid crisis is enormous and growing every day and ravaging communities across the nation.

Over-promotion, overprescribing, and the illegal sale and use of prescription opioids helped start a crisis that also was fueled by drug cartels, stigma, and poverty. There are clear solutions that offer an opportunity to improve the situation, but we must be willing to work collaboratively to implement them. We cannot just address the opioid crisis – we have to address the wider prevalence of substance use disorder, and the legal and societal attitudes toward it.

Through our research funded under the Indiana University Responding to the Addictions Crisis Grand Challenge initiative, we have identified specific steps we can take toward a healthier, more resilient future. Following conversations with public health officials, researchers, criminal justice professionals, healthcare providers, and policymakers who deal with the crisis on a practical, day-to-day basis, we learned more about the crisis than even the most dramatic news stories could communicate. This crisis stresses our institutions to an unparalleled extent; hardworking public health departments, emergency rooms, treatment facilities, child services, community agencies, law enforcement, jails, and prisons frequently are overwhelmed.

An effective response will require evidence-based and -informed solutions, along with unprecedented collaborations at the local, state, and national level, but it can be done, and there are things we can do – starting now – to help.

First and most importantly, we must reduce the number of deaths from opioid overdoses in Indiana.

Naloxone, also known as Narcan in its nasal spray form, is a highly effective opioid overdose reversal drug. As recommended by Surgeon General, and former Indiana State Health Commissioner, Dr. Jerome Adams, this life saving drug should be everywhere the crisis is. The federal government and Indiana legislature must do their part to assure that emergency service and health care providers, law enforcement, community agencies, as well as individuals who use drugs and their families and friends can easily and affordably access these drugs.

In addition to stopping avoidable deaths, we can keep people healthier and significantly reduce the spread of dangerous, often deadly, and costly diseases like HIV and Hepatitis through proven harm reduction strategies. Syringe exchange programs are a vital public health tool proven to reduce death and transmitted diseases while not increasing addiction. We must renew our efforts to provide these programs and educate communities about their value.

Second, we cannot arrest our way out of this crisis.

This is a statement we repeatedly heard in our interviews, including from stakeholders in law enforcement, the state’s court systems, as well as public health and healthcare. Filling our jails and prisons beyond capacity with individuals suffering from substance use disorder, or who committed crimes related to their substance use, will not stop this crisis. We have to address this as an issue of maintaining and improving community health and resilience.

Finally, it is critical we reduce stigma related to substance use disorder.

Seeing this crisis as largely one related to health will reduce stigma. Opioid addiction is a challenging, complex illness to manage and treat, demanding easy access to low-cost care (especially medication-assisted treatment), an array of wrap around services, and an understanding that relapse is often part of the recovery process.

However, the stigmatization of people who use drugs negatively influences the way that policies are created and implemented, and fosters harmful behaviors in individuals, families, and communities facing challenges related to substance use. Notable progress has been made to improve public education on the nature of substance use disorder, which can help reduce stigma, and to enhance the quality of services and to reduce access and cost barriers to care. The expansion of Medicaid coverage to include support services, and the availability of more evidence-informed care within the Department of Correction, are positive steps, but more is needed to ensure access to comprehensive systems of care in every Indiana community. And more can be done to include those most affected – our neighbors and families facing substance use disorder – in our crisis response. Their lived experiences can provide essential insights as we develop and implement policy. We would be wise to take note.

In wide-ranging interviews with experts from across the state, our team’s focus through this research has been on identifying barriers created by laws and policies that impeded effective interventions and opportunities that exist for improving our response efforts. We need common-sense syringe laws. Better understanding of medication assisted treatment. Reformations to Medicaid that prevent gaps in coverage. And more inclusive policymaking and program management to include the voices of those directly facing substance use disorder.

While no one-size-fits-all solutions exist, we are encouraged by progress that has been made toward improving the health and safety of our families, friends, and neighbors. By acting upon these and the other recommendations offered by experts across our state, we can chart a path toward a truly healthier, more resilient, state.

Nicolas Terry, Ross Silverman, and Aila Hoss are Professors at Indiana University.

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