Policy Brief; July 2024
Contributors: Dr. Ted Miller, PIRE; Dr. Lindsey Vuolo, Partnership to End Addiction; Aneri Pattani, KFF Health News; & Rayford Etherton, Helios
THE NEED
ADDRESSING ADVERSE CHILD EXPERIENCES STEMMING FROM THE OPIOID CRISIS (Dr. Ted Miller, PIRE)
The 35 million Americans who have repeatedly misused opioids had an average of 0.8 children when they started misusing (National Survey on Drug Use and Health, 2002-2019)
Child maltreatment, divorce, parental incarceration, discrimination, community violence, death in the family and a myriad of other adversities in a child’s life are called Adverse Childhood Experiences (ACEs). The greater the number of ACEs that go untreated increases, the greater the lifetime risk of developing substance use disorder including opioid use, depression, self-harm, interpersonal violence, asthma, arthritis, heart disease, and cancer. Evidence-based ways to help ACEs-exposed children and their families include:
Screening to identify them,
Helping a parent to become a stable adult in their life through supportive interventions (e.g., using Nurse-Family Partnership home visitation prenatally through age 2, child-parent psychotherapy at age 4, the Strengthening Families Program at ages 11-12),
Moving parents onto long-term medication-assisted therapy and a transitional stay in inpatient/recovery housing that allows children to stay with them, and
Peer-to-peer support groups for adults with a partner who is misusing opioids and separately for children of misusing parents.
Mental health treatment and support for children exposed to ACEs from opioids is critical, including allowances for more school counselors from preschool and on. Identified children need a case manager. Coordinating with Medicaid, affected children should be offered a free round of group cognitive-behavioral therapy and as necessary, one-on-one follow-up treatment for depression/anxiety or aggression.
Mass media campaigns educating parents and the public about ACEs and how we respond to them, as well as reducing the stigma attached to ACEs and their treatment.
THE APPROACH
THE MOST EFFECTIVE RESPONSE TO THE OPIOID CRISIS IS A PUBLIC HEALTH APPROACH, WHICH INCLUDES FIVE KEY ELEMENTS (Dr. Lindsey Vuolo, Partnership to End Addiction)
Defining the scope and nature of the problem: Addiction is a disease caused by a combination of behavioral, environmental, and biological factors. The punitive approach frames substance use and addiction as a moral failing, which fails to address the problem. Drug overdoses have increased dramatically, with more than 100,000 people dying every year, increasingly due to opioids.
Identifying risk and protective factors: Many factors contribute to an individual’s risk for substance use, including family history of addiction, ACEs, and early use of substances. Research shows that protective factors, such as healthy youth development and building resilience, can counteract these risks.
Addressing determinants of substance use: We know what works to prevent and treat substance use and support people in recovery. The most effective way to prevent substance use is with an early and broad approach. Effective treatment for opioid use disorder includes medications for opioid use disorder, behavioral therapies, and recovery supports. Harm reduction strategies, such as syringe service programs and naloxone distribution and access, are also supported by research.
Disseminating knowledge and bolstering systems for widespread adoption: The biggest barriers to implementing a public health approach are stigma (which often results in support for punitive rather than public health strategies) and the major changes required in large systems such as the health care and criminal justice systems.
Monitoring impact of interventions: It is critical to use data when determining how to spend the opioid settlement funds and to monitor the impact of the funds (i.e., data collection, needs assessments, resource mapping, quality assurance, impact measures, ensuring racial equity).
We are currently shifting from a criminalized/punitive approach to a public health approach, a seismic shift in how our nation addresses addiction. The opioid settlement funds provide a critical opportunity to support this transformation.
THE LANDSCAPE
HOW ARE SETTLEMENT MONIES BEING USED ACROSS THE NATION? (Aneri Pattani, KFF Health News)
Companies that made, distributed, and sold prescription opioid painkillers have agreed to pay more than $50 billion in restitution to settle lawsuits about their role in the overdose epidemic. The money has already begun flowing to state and local governments and will continue for more than a decade. Most of the settlement agreements require states to spend at least 85% of the funds on “opioid remediation,” a term that is loosely defined through a list of more than 100 suggested interventions. However, jurisdictions have flexibility in how they spend the money beyond that list. There are also wide variations in who controls the money in each state and state-level laws/regulations that specify how the funds can or cannot be used.
KFF Health News has been tracking how opioid settlement cash is spent in a multi-year reporting project. Some common themes that have arisen include:
The public’s desire for greater transparency on how spending decisions are made and where the money ultimately goes
The tension between jurisdictions waiting to spend the money until they develop a comprehensive plan and using the funds urgently to stem overdose deaths
The controversy over spending settlement funds on law enforcement efforts
Companies eager to get a piece of the windfall flooding officials in charge of the funds with information about their products and services
General agreement that some of the funds should go toward youth-focused prevention efforts, but disagreement about the best programs/strategies to achieve that goal
For more information, including databases showing how much money jurisdictions are receiving, who controls it, and how it’s being spent, visit these sites:
A SOLUTION
USING TECHNOLOGY TO IDENTIFY BEST PRACTICES FOR OUR COMMUNITIES (Rayford Etherton, Helios)
In June 2023, a group of national leaders gathered in Mobile, Alabama to form The Helios Alliance – a group of likeminded individuals and organizations who have committed to use innovative, transformative, evidence-based technologies and methodologies to address systemic issues related to health, safety, and the quality of life.
The Alliance aims to collaborate with decision makers around the country to develop and maintain a dynamic simulation platform for transparent, evidence-based, data-driven predictions to address the opioid crisis effectively. The Alliance has developed a groundbreaking simulation platform that uniquely integrates system dynamics modeling with AI analytics. As of January 2024, the national model structure is complete.
The Opioid Abatement Model is a simplified version of the real world that can evaluate various policies, judge their likely success or failure, and provide a clear idea of what will be necessary to abate the opioid epidemic in the appropriate geographic region.
The Helios approach allows us to:
Assess the current recovery ecosystem.
Predict impact before investment in abatement programs.
Monitor progress during all stages of programming.
Measure outcomes along the continuum of care, from prevention to treatment.
Identify gaps in services provided within the opioid space.
Provide each entity with evidence to support additional funding requests from public and private institutions.
Support spending and funding decisions by providing evidence-based reasoning.
The Model will continually update with new data, becoming “smarter” as the data system expands. Notably, our model mirrors the dynamic nature of the real world – it has the capacity to consider new prescription drugs to treat addiction and quickly evaluate their impact on the population. This agility enables a swift response, allowing for quick adjustments, if necessary.
For additional information, click here.
To reach out to the Helios Alliance team, click here.
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