A Comprehensive Approach to Addressing the Opioid Crisis

Author(s):  
Michael R. Fraser ◽  
Mark Levine

An effective public health response to the opioid crisis includes understanding the many different contributors to the crisis and the need for a comprehensive versus piecemeal approach to addressing it. In this chapter, the authors add to prior work that describes the essential elements of a comprehensive response to the opioid crisis. Building on their commentary published in 2018, the authors state that there is a need to propel the governmental public health agency response well beyond its traditional role as data broker and convener of primarily health care partners toward a more contemporary and much-needed focus on the primary prevention of opioid misuse and addiction that forges new ground with social service agencies, employment and housing programs, law enforcement and corrections, addiction treatment providers and substance abuse prevention agencies, and many other sectors equally engaged in ending the opioid crisis.

2021 ◽  
Vol 15 ◽  
pp. 117822182110286
Author(s):  
Kristen Henretty ◽  
Howard Padwa ◽  
Katherine Treiman ◽  
Marylou Gilbert ◽  
Tami L Mark

Background: As the coronavirus pandemic public health emergency begins to ebb in the United States, policymakers and providers need to evaluate how the addiction treatment system functioned during the public health emergency and draw lessons for future emergencies. One important question is whether the pandemic curtailed the use of addiction treatment and the extent to which telehealth was able to mitigate access barriers. Methods: To begin to answer this question, we conducted a survey of specialty addiction treatment providers in California from June 2020 through July 2020. The survey focused specifically on provider organizations that served Medicaid beneficiaries. Results: Of the 133 respondents, 50% reported a decrease in patients since the stay-at-home order in March 2020, with the largest decline among new patients, and 58% said more patients were relapsing. Eighty-one percent of providers said that telemedicine use had increased since the stay-at-home order. Most said that telemedicine had moderately (48%) or completely (30%) addressed access barriers. Conclusion: More efforts are needed to ensure that patients, and in particular new patients, receive addiction treatment during public health emergencies.


2018 ◽  
Vol 38 (6) ◽  
pp. 224-233 ◽  
Author(s):  
Lisa Belzak ◽  
Jessica Halverson

Introduction This review provides a national summary of what is currently known about the Canadian opioid crisis with respect to opioid-related deaths and harms and potential risk factors as of December 2017. Methods We reviewed all public-facing opioid-related surveillance or epidemiological reports published by provincial and territorial ministries of health and chief coroners’ or medical examiners’ offices. In addition, we reviewed publications from federal partners and reports and articles published prior to December 2017. We synthesized the evidence by comparing provincial and territorial opioid-related mortality and morbidity rates with the national rates to look for regional trends. Results The opioid crisis has affected every region of the country, although some jurisdictions have been impacted more than others. As of 2016, apparent opioid-related deaths and hospitalization rates were highest in the western provinces of British Columbia and Alberta and in both Yukon and the Northwest Territories. Nationally, most apparent opioid-related deaths occurred among males; individuals between 30 and 39 years of age accounted for the greatest proportion. Current evidence suggests regional age and sex differences with respect to health outcomes, especially when synthetic opioids are involved. However, differences between data collection methods and reporting requirements may impact the interpretation and comparability of reported data. Conclusion This report identifies gaps in evidence and areas for further investigation to improve our understanding of the national opioid crisis. The Public Health Agency of Canada will continue to work closely with the provinces, territories and national partners to further refine and standardize national data collection, conduct special studies and expand information-sharing to improve the evidence needed to inform public health action and prevent opioid-related deaths and harms.


2018 ◽  
Vol 133 (1_suppl) ◽  
pp. 24S-34S ◽  
Author(s):  
Brendan Saloner ◽  
Emma E. McGinty ◽  
Leo Beletsky ◽  
Ricky Bluthenthal ◽  
Chris Beyrer ◽  
...  

Drug overdose is now the leading cause of injury death in the United States. Most overdose fatalities involve opioids, which include prescription medication, heroin, and illicit fentanyl. Current data reveal that the overdose crisis affects all demographic groups and that overdose rates are now rising most rapidly among African Americans. We provide a public health perspective that can be used to mobilize a comprehensive local, state, and national response to the opioid crisis. We argue that framing the crisis from a public health perspective requires considering the interaction of multiple determinants, including structural factors (eg, poverty and racism), the inadequate management of pain, and poor access to addiction treatment and harm-reduction services (eg, syringe services). We propose a novel ecological framework for harmful opioid use that provides multiple recommendations to improve public health and clinical practice, including improved data collection to guide resource allocation, steps to increase safer prescribing, stigma-reduction campaigns, increased spending on harm reduction and treatment, criminal justice policy reform, and regulatory changes related to controlled substances. Focusing on these opportunities provides the greatest chance of making a measured and sustained impact on overdose and related harms.


Author(s):  
Sarah Palmeter

In the completion of my practicum at the Public Health Agency of Canada (PHAC) this summer, I worked to develop a surveillance knowledge product to support the national surveillance of developmental disorders. This project used Statistics Canada’s 2017 Canadian Survey on Disability to investigate the burden of developmental disorders in Canada. Developmental disorders are conditions with onset in the developmental period. They are associated with developmental deficits and impairments of personal, social, academic, and occupational function. The project objectives are to estimate the prevalence of developmental disorders in Canadians 15 years of age or older, overall and by age and sex, as well as report on the age of diagnosis, disability severity, and disability co-occurrence in those with developmental disorders. The majority of the analysis has been completed and preliminary results completed, which cannot be released prior to PHAC publication. Although not highly prevalent, developmental disorders are associated with a high level of disability in young Canadians. Early detection and interventions have been shown to improve health and social outcomes among affected individuals. Understanding the burden of developmental disorders in Canada is essential to the development of public health policies and services.


2020 ◽  
Vol 11 (SPL1) ◽  
pp. 967-971
Author(s):  
Poonam Thakre ◽  
Waqar M. Naqvi ◽  
Trupti Deshmukh ◽  
Nikhil Ingole ◽  
Sourabh Deshmukh

The emergence in China of 2019 of severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) previously provisionally names 2019-nCoV disease (COVID19) caused major global outbreak and is a major public health problem. On 30 January 2020, the WHO declared COVID19 to be the sixth international public health emergency. This present pandemic has engrossed the globe with a high rate of mortality. As a front line practitioner, physiotherapists are expected to be getting in direct contact with patients infected with the virus. That’s why it is necessary for understanding the many aspects of their role in the identification, contains, reduces and treats the symptoms of this disease. The main presentation is the involvement of respiratory system with symptoms like fever, cough, sore throat, sneezing and characteristics of pneumonia leads to ARDS(Acute respiratory distress syndrome) also land up in multiorgan dysfunction syndrome. This text describes and suggests physiotherapy management of acute COVID-19 patients. It also includes recommendations and guidelines for physiotherapy planning and management. It also covers the guidelines regarding personal care and equipment used for treatment which can be used in the treatment of acute adult patients with suspected or confirmed COVID-19.


Author(s):  
Ross C. Brownson ◽  
Graham A. Colditz ◽  
Enola K. Proctor

This chapter highlights just a sample of the many rich areas for dissemination and implementation research that will assist us in shortening the gap between discovery and practice, thus beginning to realize the benefits of research for patients, families, and communities. Greater emphasis on implementation in challenging settings, including lower and middle-income countries and underresourced communities in higher income countries will add to the lessons we must learn to fully reap the benefit of our advances in dissemination and implementation research methods. Moreover, collaboration and multidisciplinary approaches to dissemination and implementation research will help to make efforts more consistent and more effective moving forward. Thus, we will be better able to identify knowledge gaps that need to be addressed in future dissemination and implementation research, ultimately informing the practice and policies of clinical care and public health services.


Author(s):  
Joshua M. Sharfstein

Issues of responsibility and blame are very rarely discussed in public health training, but are seldom forgotten in practice. Blame often follows a crisis, and leaders of health agencies should be able to think strategically about how to handle such accusations before being faced with the pain of dealing with them. When the health agency is not at all at fault, officials can make the case for a strong public health response without reservation. When the agency is entirely to blame, a quick and sincere apology can allow the agency to retain credibility. The most difficult situation is when the agency is partly to blame. The goal in this situation is to accept the appropriate amount of blame while working quickly to resolve the crisis.


Author(s):  
Joshua M. Sharfstein

Firefighters fight fires. Police officers race to crime scenes, sirens blaring. And health officials? Health officials respond to crises. There are infectious disease crises, budget crises, environmental health crises, human resources crises—and many more. At such critical moments, what happens next really matters. A strong response can generate greater credibility and authority for a health agency and its leadership, while a bungled response can lead to humiliation and even resignation. Health officials must be able to manage and communicate effectively as emotions run high, communities become engaged, politicians lean in, and journalists circle. In popular imagination, leaders intuitively rise to the challenge of a crisis: Either they have what it takes or they do not. In fact, preparation is invaluable, and critical skills can be learned and practiced. Students and health officials alike can prepare not only to avoid catastrophe during crises, but to take advantage of new opportunities for health improvement. The Public Health Crisis Survival Guide provides historical perspective, managerial insight, and strategic guidance to help health officials at all levels not just survive but thrive in the most challenging of times.


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