From 1999-2019, nearly 500,000 people died from an overdose involving any opioid, including prescription and illicit opioids (1). A new HBO documentary called Crime of the Century documents the beginning of the ongoing opioid epidemic to the unethical practices of U.S. drug makers, especially the Sackler family, principals of Purdue Pharma. Currently 24 states are engaged in litigation countering this family's attempt to seek immunity for their role in fueling the crisis (2).
Overdose, suicide, and alcohol-related deaths, together known as “deaths of despair," are increasing. As a result, after decades of living longer and longer lives, the life expectancy of Americans has now been reduced (3).
The July/August issue of the Journal of Public Health Management and Practice focuses on a series of articles documenting a variety of programs and policies to reduce the overwhelming harms caused by opiates. These efforts include surveillance, syringe service availability, and responsible prescribing programs. William Swann and co-authors studied the opioid policy and programs offered by local governments. Of 358 county governments, nineteen opioid policy and programmatic activities were analyzed. The study lists possible interventions by complexity. Police officers carrying naloxone was less complex than implementing syringe exchange programs. County population size was associated with the extent of implementation activity. Sparsely populated counties needed more assistance to implement comprehensive programs.
Syringe service programs (SSPs), also known as needle exchange programs, can prevent disease by offering clean needles and other services to people using drugs. Ashley Brooks-Russell and co-authors surveyed registered voters in 8 Colorado counties to learn about their awareness and attitudes toward syringe service programs. They also wanted to learn the reactions of these voters to expanding these services. More than ¾ of the surveyed individuals were familiar with SSPs, although most did not know they were legal. The majority believed supervised sites should be legal. However, there were significant differences in attitude towards SSPs by political party; 90% of Democrats as opposed to 51% of Republicans believed this program should be used as a preventive measure.
Several articles in the issue examine clinical interventions to decrease the high rate of opioid prescribing. Sarah Ball and co-authors examine longitudinal trends in opioid prescribing data from 2010 to 2018. Comprehensive dispensing data is available in the South Carolina Prescription Drug Monitoring Program (SCPDMP). Public health policy, legislative action, and multiple clinical interventions are succeeding in reducing the high rate of opioid prescribing. Opioid prescribing decreased 41% in the period 2010-2018.
Jacob Shreffler and co-authors also advocate for using PDMP data as a guide to responsible prescribing in Kentucky. Because of the severe impact of the opioid epidemic, Kentucky was an early state to implement a program requiring physicians to request a report on the patient before prescribing a controlled substance and then counsel the individual on abuse potential. Kentucky also shares PDMP data with 10 other states. The authors conducted a retrospective observational study in Jefferson County of all 575 individuals who died of opioid overdose between 2017 and 2018, cross-referencing with Kentucky's PDMP (Kentucky All Schedule Prescription Electronic Reporting System). They found that review of PDMP data can prevent unnecessary opioid prescribing. They also found that multiple prescriptions were written for or filled for deceased individuals and recommended that legislators enact a Void All Prescription (VAP) alert policy to end this.
The ASTHO “State of Health" column for this issue focuses on evidence-based actions in overdose prevention and surveillance. Ten promising strategies are presented to address the opioid epidemic. To engage these evidence-based strategies, collaboration with other stakeholders and partners is outlined so as to get maximal impact from available resources.
- Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. Available at http://wonder.cdc.gov. 5/19/21
- https://www.wbur.org/hereandnow/2021/05/07/crime-of-the-century-opioid-hbo accessed 5/19/2021.
- https://www.cdc.gov/surveillance/blogs-stories/deaths-of-dispair.html accessed 5/19/2021
Lloyd F. Novick, MD, MPH Justin B. Moore, PhD, MS
Editor-in-Chief Associate Editor