Commentary: Can Oklahoma Eliminate Overdose Deaths?
Friday, March 8, 2019
Oklahoma has been making progress in fighting the opioid epidemic. But there's still a lot of work to be done.
While the death rate from prescription opioids is on the decline here, the number of opioid prescriptions written in the state continues to vastly outpace the national average. Also, deaths from heroin overdoses have been climbing — up by more than 50 percent between 2015 and 2016 — and that could be a byproduct of stricter state regulations that aim to curb opioid prescribing.
So in late February, I was one of about 60 people from across Oklahoma invited to brainstorm ideas during a one-day exercise to find solutions to the state's opioid crisis. The Oklahoma Primary Healthcare Improvement Cooperative convened the meeting at the Tatanka Ranch in Stroud.
The cooperative was created in 2014 to help doctors and nurses across the state do their jobs better by implementing best practices as determined by medical research. It works like an agricultural extension service, with academic doctors and nurses acting like farm bureau experts and visiting local offices throughout the state to share their wisdom.
The conveners of the opioid meeting divided us into small groups and focused on two really tough questions:
- What if Oklahoma had zero overdose deaths?
- What would be expected of each of us to make that happen?
Academic physicians (like me) from the state's two major research universities, were sprinkled among the groups, which also included community and rural physicians, some of whom specialize in medication-assisted treatment for substance use.
But what made the one-day summit unique in my eyes was the inclusion of professionals well beyond doctors, nurses and physician assistants. Pharmacists were there, as were officials from Oklahoma's Medicaid agency and the state's Bureau of Narcotics and Dangerous Drugs, which administers Oklahoma's Prescription Monitoring Program.
Thirty-seven states now give health care providers access to online tools that let them see the prescriptions for controlled substances, such as opioids, that a patient has received. This information can help prevent "doctor shopping" by people seeking drugs and it can help clinicians be aware of potential overuse.
Given how disruptive opioid addiction can be for families, there were also child welfare and mental health professionals who reported on programs to help addicted mothers overcome opioids and find pathways to win back custody of their children.
The summit also included representatives from law enforcement and community-based support programs, such as a prison diversion initiative aimed at providing treatment and help instead of incarceration for nonviolent male offenders.
The strength of the meeting was that it brought together people who work on different aspects of the same broad problem, who may never have had the chance to meet one another in their day-to-day work and consider ideas from others' perspectives.
"We're all blindfolded people working on our own aspect of an elephant," one person noted. "And this has allowed us to remove our blindfolds and see the whole elephant in the room."
One set of conversations early in the day asked us to put ourselves on a complicated flow diagram of where, when and how opioid prescribing occurs.
Some people were involved in fielding patients' complaints. Others worked in doctors' offices or hospital emergency rooms, right on through to the dispensing of medicines in pharmacies. Still others were on the law enforcement, social service, and payer sides of such transactions.
By visualizing where each of us work along the opioid continuum, we could more easily imagine ways to improve things and implement new educational approaches to better inform the public about the risks and benefits of opioid use.
Suggestions for lessening the impact of opioid abuse included both "upstream" and "downstream" components.
Upstream refers to preventing opioid abuse and addiction before it starts. Ideas for that included more interdisciplinary and interagency cooperation, and pushing our state legislature to consider the health effects of all bills that are enacted into law.
Downstream suggestions included widening availability and accessibility of mental health and substance abuse treatment services, something Oklahoma sorely lacks. Other ideas included better data monitoring and sharing tools.
I left the meeting mulling over what we had really accomplished.
I don't think we'll ever realistically get to zero opioid deaths. But it's certainly a worthy aspiration. In order for us to move in that direction, we have to treat addiction as a medical problem — not a character flaw — and place equal value on every human life.
Further, we have to accept the idea that we have excellent medical treatment for opioid addiction and be willing to provide it in all kinds of health care settings, including jails and prisons, without preconditions.
If we could achieve this mindset, people would have the chance to live longer, more productive lives. Family and childhood trauma could be greatly diminished, too.
The meeting prompted me to learn more about intranasal naloxone, an opioid antidote, and to carry it with me. If I can use it, certainly anyone can. I also plan to lobby to make medication-assisted treatment more widely available.
The attendees concluded it would be important for those of us in different sectors to keep in touch and sustain the dialogue. We also pledged to better educate each other, our lawmakers and the public.
But as inspiring as it was to be part of the meeting, it was abundantly clear that complex issues such as opioid use and abuse don't lend themselves to one-day solutions.
John Henning Schumann is a writer and doctor in Tulsa, Okla. He serves as president of the University of Oklahoma, Tulsa. He also hosts Public Radio Tulsa's Medical Mondays and is on Twitter: @GlassHospital.
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