In case you haven’t noticed, the underlying theme of my blogs have been getting to the heart of what makes me happy. There aren’t too many bright and shiny benefits to the opioid epidemic, but for me it set me on a path of purpose.
In my career, my passion project was working at many different levels on trying to avert the opioid epidemic. In the early years, I watched with horror as hydrocodone prescribing volume shot into third, second then first place. I oversaw surveillance of drug use patterns, and this was alarming. WTF was going on? This was almost 20 years ago. We started trending the overall use of opioid medications and the rest is history. We all know how that turned out.
Early on, I decided we (the health insurance) needed to partner up with other key partners to get a handle on this. I invited representatives from the Bureau of Narcotic Enforcement, DEA, Board of Pharmacy, … a group of thought leaders, government officials and practitioners who came to meet with me in Williamsville NY because they also recognized there was a serious problem.
Over the years, we implemented programs some were effective and some were short-sighted. One of our biggest successes was the I-STOP program which created a database for controlled substance monitoring in the state of NY which was one of the first prescription monitoring programs in the country. It allowed pharmacists and prescribers to track all controlled substances prescriptions a patient was receiving from other prescribers and pharmacies. The intent was to put a stop on doctor shopping practices that indicated drug misuse patterns.
It was short-sighted because it put doctors in a position where, if they identified someone who was doctor shopping, they would not prescribe anything, rather than get the patient into treatment, patients were left to fend for themselves. Going cold turkey is not an option for people addicted to opioids. People were forced to buy drugs illegally. The consequences of this have led to use of heroin and fentanyl-laced everything which is deadly resulting in more overdose deaths of all time. It was an unintentional consequence of trying to avert a crisis which caused a crisis.
In the meantime, we scrambled to train prescribers on how to prescribe opioids or treat substance use disorder to avert the abandonment of patients who needed opioids. What a mess! Yeah, we got the prescribing of opioids down but now we had so many people dying of drug overdoses.
This is a snapshot of where we are now. Lately, I have been championing for increasing access for substance use treatment through pharmacist dispensing, although, this is an uphill battle. The medication assisted treatment clinics are territorial and heavily regulated by SAMHSA. Laws would need to be changed, pharmacists would need specialized credentialing, prescribers would have to agree that pharmacists can treat patients with medication for substance use disorder (Canadian pharmacists are already doing this).
I have been reaching out to organizations like SAMHSA and big corporations like CVS/Aetna to lend a voice to these ideas. I don’t have a big voice on my own. It all seems logical to me, but I can’t do it on my own. No one wants to rock the boat for how things are done or relinquish turf. Maybe I can use my blog platform to air out these ideas and get feedback on how to make these ideas a reality. I have written several articles and spoken on panels regarding these ideas.
My dream job would be to be able to continue this work to lead and make changes because we have learned so much from our mistakes and we have such a better understanding for what the issues are. Harm reduction and access to replacement medication treatments that work are powerful tools to combat the opioid epidemic and radically change the tools we have to save lives. I would like the opportunity to continue this work. It doesn’t feel like work to me, it feels like purpose and meets my requirement of doing something profound. I continue to search for ways to make this happen.