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The Opioid Epidemic and a Long Overdue Response

Linda Rose Frank, PhD, MSN, ACRN, FAAN
Associate Professor of Public Health, Medicine, and Nursing

As we begin 2017 as the Department of Infectious Diseases and Microbiology, we must continue our efforts to address the drivers of infectious diseases within the US and worldwide. In this regard, the US Surgeon General released a report on the opioid epidemic in October 2016.1 Pitt Public Health has recently funded several projects focused on substance use. The University of Pittsburgh’s Institute of Politics spearheaded a report on opioid use in our region and potential solutions that was released in fall 2016.2 Time has come for a thoughtful, scientific, targeted, and inclusive response across all sectors of stakeholders.

This growing and lethal public health problem must be addressed with the resources, commitment, and resolve by our department, Pitt Public Health, the health care system and the community in a coordinated way. It is not possible to discuss HIV or viral hepatitis without discussing substance misuse and abuse as they are intertwined, making a coordinated and effective response by the public health community so important. Nor is it possible to discuss opioid use without addressing the lack of mental health and substance use services, and issues of poverty, unemployment, and homelessness.
A recent report3 from the Institute for Health Care Improvement (IHI) identifies causes of the worsening of this epidemic:

  1. Lack of coordination of approaches and resources
  2. Lack of implementation of promising practices
  3. Failure to engage local communities and across multiple stakeholders
  4. Failure to spread promising practices
  5. Direct and indirect counter forces by the pharmaceutical industry
  6. Lack of awareness among patients and consumers of the danger of prescription opioids”

The opioid epidemic is not limited to urban areas but has taken hold in suburban and rural areas in our region and across the US. An adequate response requires that interventions developed need to be utilized “in the field” through engagement with communities for joint problem solving and design of interventions. Intervention in this opioid epidemic cannot be accomplished by sitting behind a desk in an office. A system-wide approach across communities within locales and regions is needed. In my view, this cannot be accomplished without coordinated action. Within this context, new and innovative interventions need to be developed that address co-morbidities and other “drivers” of substance use. There has to be retraining of providers of health care and not just physicians but pharmacists, nurses, nurse practitioners, physician assistants, and dentists. Training must include not just opioid prescribing practices but alternative treatment options for pain management, evidenced-based substance use treatment interventions, harm reduction, use of naloxone to prevent overdose deaths, and addressing stigma associated with substance use.
For our department and Pitt Public Health, there are many actions that can be taken to assume the leadership needed in this epidemic.
Integrate substance use and misuse treatment and intervention content in curricula across programs.

  1. It is not enough just to describe the scope of the problem. Students and faculty need to be challenged to be engaged in developing approaches to solve this problem and working in collaboration the community.
  2. For faculty not already involved in public health practice or direct work with community organizations, they should consider obtaining this type of experience.
  3. Collaboration across department and schools within the University of Pittsburgh are needed to develop a robust research and intervention plan.
  4. Development of ongoing forums for community collaboration and input into this plan should be ongoing and comprised of genuine partnerships.
  5. Health professions and public health training initiatives should be continued through GSPH training centers, such as the Public Health Training Center and the Mid-Atlantic AIDS Education & Training Center.
  6. Incorporation of the opioid misuse prevention and treatment as well as related issues of mental health care, hepatitis, and HIV should be included in strategic planning within IDM, Pitt Public Health and the University of Pittsburgh Health Sciences.

1 Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, DHHS, 2016.
2 Continuum Of Care Approach: Western Pennsylvania’s Response To The Opioid Epidemic, Institute of Politics, University of Pittsburgh, 2016.
3 Martin L, Laderman, M, Hyatt, J, Krueger, J. Addressing the Opioid Crisis in the United States. IHI Innovation Report, Cambridge, Massachusetts: Institute for Health Care Improvement, April 2016





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