'Call for Targeted Policies to Address Opioid Epidemic'

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'Focus should be on communities of color, the incarcerated, Gen Z'

During a panel discussion on the state of the opioid epidemic, former White House officials, advocates, and other policy experts called for more evidence-based prevention messaging, continued efforts to improve access to treatment, and an increased focus on vulnerable populations.

Fatal overdose deaths fell by 10.6% from April 2023 to April 2024, the first decline of that magnitude in decades, according to CDC dataopens in a new tab or window. Some scientists predict an even greater decline in fatal overdoses after federal surveys incorporate changes at the state level.

Still, former White House officials were not completely optimistic about the data.

During the panel discussion, which was hosted by the Bipartisan Policy Center (BPC) and the Foundation for Opioid Response Efforts, Regina LaBelle, JD, of the Georgetown University Law Center in Washington, D.C., and former acting director of the White House Office of National Drug Control Policy under the Biden administration, said the decline is "great news."

However, it's important to look beyond the "totality of the data" to see who is being left behind, she said. Washington, D.C., for example, is ranked among the top five places in the country for overdose deaths, with a rate of 49.9 per 100,000opens in a new tab or window for opioid overdose deaths specifically.

Looking solely at mortality data is what researchers do because it's what's available, LaBelle said, but "it's not always the best metric for success."

Jim Carroll, JD, former director of the Office of National Drug Control Policy under the Trump administration and a member of the BPC Youth Mental Health and Substance Use Task Force, said everyone working in this field was "thrilled" to see a 10,000-person drop in overdose deaths, but that isn't enough.

"This is a crisis. And the fact that we've made some improvements means that hopefully we're headed in the right direction," Carroll said. Like LaBelle, he highlighted the need to focus on communities of color and on treatment for everyone. Currently, most treatment centers are male-dominated, he noted.

Margaret Kuklinski, PhD, of the School of Social Work at the University of Washington in Seattle, noted that while cigarette smoking and alcohol use are down among those ages 12 to 27, vaping, cannabis or marijuana use, and opioid use have not decreased.

"What we also see in this age range is a four-fold increase in mortality related to opioid overdose in the last 20 years," she said.

In a surveyopens in a new tab or window that the BPC and the Foundation for Opioid Response Efforts conducted in collaboration with Morning Consult in August, three out of four adults described the opioid epidemic as a major problem, but only 57% of Gen Z respondents considered it a major issue.

Asked why this generation seems less concerned about the crisis, Carroll recalled also feeling "immortal" at that age.

Growing up in the '60s and '70s, there were a lot of substances out there, he said. "You could make a lot of stupid mistakes -- I made plenty. ... But back then, they weren't necessarily fatal."

Carroll noted that the abstinence-focused campaigns of the 1980s and 1990s mostly backfired. One meta-analysisopens in a new tab or window showed that teens enrolled in the "Just Say No" programopens in a new tab or window were as likely to use drugs as those who weren't.

He said that appropriate interventions and training from peers is needed, so that young people understand they actually aren't as safe as they think they are.

Ken Shatzkes, PhD, program director for the Foundation for Opioid Response Efforts, noted that other focused policy efforts weren't as successful as some would have hoped. While changes to the X waiveropens in a new tab or window were celebrated, they didn't have the intended effect, he said, adding that only 18% of Americans in need of buprenorphine have access to it.

Alister Martin, MD, of Harvard Medical School in Boston and CEO of the nonprofit A Healthier Democracy, said he initially thought that ending the X waiver would improve access to buprenorphine, but there was only a "slight uptick."

"The reality is the picture is much more complicated," he said.

As to what policy changes could help make a difference, Martin argued that policymakers must address the telehealth provisions that allow clinicians to prescribe buprenorphine and other treatments during telehealth visits. Those provisions are expected to sunset on December 31opens in a new tab or window.

LaBelle also emphasized the importance of extending or even making permanent such provisions, stressing their importance both for rural populations and for people who are incarcerated. Incarcerated persons have the highest risk of overdose deaths on re-entering society.

Furthermore, "practice pathways" that allow emergency medicine physicians, pediatricians, and other doctors to become addiction specialists are also expected to end on December 31.

Carroll said that more investment is needed for the opioid epidemic. While the U.S. currently spends close to $40 billion, he said he thinks double or triple that amount is necessary to make substantial changes.

https://www.medpagetoday.com/publichealthpolicy/opioids/112171