What cities can do with social safety nets and data to reduce opioid deaths
By Doug Peeples, Smart Cities Council
Every 19 minutes someone dies from an opioid overdose, primarily prescribed drugs such as oxycontin and hydrocodone and the illegal drug heroin. That number reflects a staggering increase in opioid use and accidental deaths. And the rate of increase in medication-assisted treatment comes nowhere close to the almost 500% rate of increase in 'opioid use disorder' diagnoses identified from 2010 through 2016, according to a Blue Cross Blue Shield report released last year.
A group of professionals in the field and a city mayor spoke about how a data-driven social safety net can save lives during a panel discussion at Smart Cities Week in Washington, D.C. Their thoughts on the extent of the problem and new solutions offer guidance and insights for city leaders, health officials and social service agencies.
Opioids, both prescribed and illegal, cause more deaths in the U.S. than guns and car accidents, and the 59,000 opioid-related accidental deaths recorded in 2016 is said by some sources to be the highest ever in the country's history. Reversing that trend is a very tall order for public and private health professionals and the other agencies committed to the task.
Budgets and resources are both tight for many cities. And for Evan Behrle, director of addiction treatment for the Baltimore City Health Department, even more so. Maryland is one of the East Coast states with the country's highest opioid-related death rates. The city has trained thousands of citizens in the use of Naloxone, commonly referred to by its brand name Narcan, which can reverse opioid overdoses — and as Behrle said, those citizens are saving the lives of friends and family members.
The problem as he put it is, "We don't have as much Naloxone as we need. It's expensive even though it's generic."
Behrle also said treatment is often not available in rural areas. "We shouldn’t accept that there are places in America that don't have treatment available." He also recommended a treatment infrastructure, one that connects people who need help with those who have the ability to treat them.
Revere, Massachusetts Mayor Brian Arrigo echoed Behrle's sentiment. "We have some federal and state funding, but it's never enough money." The city earlier this year issued a warning about heroin mixed with the much stronger opioid fentanyl because of the high number of overdose deaths in the community of about 53,000 residents. Firefighters have carried Narcan since 2010 and police are now carrying it too.
Local officials are working on a strategy to have all city agencies work together to find alternate funding sources rather than be obligated to following the rules that come with state and federal money.
What about data? How can it help?
For Steven Kearney, PharmD medical director for state and local government at SAS Institute, data analytics can accomplish several things. It can help identify the "bad players," anomalies in practices and claims and changes in rules. But machine learning will be needed to fully take advantage of that data. He added that physicians need to be educated to be more selective regarding when and why they prescribe opioids — when they are effective and when they aren't.
Jacob Levenson, CEO of health management platform company MAP Health Management, noted that one problem is that data that could help treatment providers determine how and when to intervene for a patient is frequently unavailable. Data on patient relapses is often not available until months later and physicians may have no idea a patient is an opioid user — even though that data exists.
City outreach and engagement
"We're trying to identify every place where we could intervene for treatment. Eight out of 11 Baltimore hospitals have overdose survivor programs," Behrle said. He also recommended Law Enforcement Assisted Diversion, a program pioneered in Seattle, Washington and in use in Baltimore that takes people out of the legal system and diverts them directly to treatment.
"Most of these strategies are about engagement and we have nothing without engagement," Levenson added, referring to mothers and fathers helping their children and how much they can contribute to treatment solutions and the data needed to ensure those solutions are timely and effective. "The earlier we can intervene, the better outcome we're going to have — and it takes good data to do it."
Doug Peeples is Readiness Editor of the Smart Cities Council, which works to help cities use technology to become more livable, workable and sustainable. Register for the Council’s next Smart Cities Week Silicon Valley, May 7-9 in Santa Clara, CA.