The United States is in the midst of the worst drug crisis in the nation’s history, a toll measured in fatalities on a scale never seen before. With a record-setting 42,000+ drug overdose deaths involving an opioid in 2016, the death rate is now five times higher than it was in 1999. “The terrorist threat families in America see is not in the streets of Aleppo, it’s fentanyl coming down your street,’’ said Massachusetts Senator Ed Markey at a 2017 summit on drug abuse.
A 2014 study in JAMA Psychiatry found 75 percent of heroin users in treatment started their addiction with painkillers, and a 2015 analysis by the CDC found that people who are addicted to painkillers are 40 times more likely to be addicted to heroin. The opioid epidemic is real and in it’s in our face.
Innovative Solutions to Tackle the Opioid Crisis
HIDTA’s ODMAP (serving Maryland, Washington, DC, Virginia, and parts of West Virginia) provides real-time overdose surveillance data that is mapped across jurisdictions to support public safety and health efforts to mobilize an immediate response to an overdose spike. The mobile instrument links first responders on scene to a mapping tool to track overdoses in order to stimulate real-time response and strategic analysis across jurisdictions.
If overdoses happen in one community, public health & law enforcement officials are then notified by ODMAP, which predicts where the “epidemic” could spread in the next eight -10 hours. Since its launch in January 2017, 70 counties across 19 states are actively contributing data to the system.
Virtual Pharmacies and E-prescriptions
The likes of Pill Pack, Zip Drug and Capsule are committing to revolutionize the pharmacy market through instant prescription delivery to ensure that patients always have the medications they need. Most accept all insurers and copays don’t change. How is this approach beneficial in the opioid crisis?
These efforts in actuality may prevent duplicate and forged prescriptions, reduce dosing errors, enable cross-referencing of prescription monitoring program databases and reduce visits to clinics.
Alternatives to Pain Management
Non-opioid Pharmacological Therapies
A number of non-opioid pharmacological therapies are in the clinical trial pipeline, having been derived from capsaicin in chili peppers to snail venoms. It remains to be seen if they will find mainstream adoption, and what real-world side effects are experienced by patients.
According to the National Institute on Drug Abuse, there are about 14,500 drug treatment facilities in the U.S. However, between alcohol, illegal drugs and prescription medicines, there are some 86 million Americans who battle substance abuse. That's a ratio of one treatment facility for every 6,000 addicts, which is not nearly enough.
Pear Therapeutics’ reSET is an FDA-approved prescription digital therapeutic to be used in conjunction with standard outpatient treatment for substance use disorder. It was evaluated in a clinical trial of 507 patients with substance abuse disorder across 10 treatment centers in the USA over 12 weeks. Abstinence was measured twice weekly via urine analysis, breathalyzer, and self-reports.
Catch Pear Therapeutics in action at our Global Gathering in SFO on 4th Oct, 2018.
Wearables (we’re thinking FDA approved stimulator Quell) or cryotherapy (FDA cleared Iovera, for eg), there’s plenty in the offing. Currently available for purchase without prescription, it remains to be seen if these will become mainstream pain killers advocated and endorsed by practitioners. For $250, it seems like a good investment for chronic pain sufferers.
Virtual Reality is getting real. Think AppliedVR and Cedars Sinai, who have worked on a number of trials using VR in acute and chronic pain patients. Or Project Brave Heart at Stanford University for children who have a scheduled cardiac catheterization procedure so they can learn about the procedure and practice relaxation techniques at home.
While VR seems ripe with opportunity questions remain to be answered as many patients are medically ineligible to use VR in the hospital (seizures, stroke, motion sickness), or do not want to use VR as their treatment (consider for a moment what it’s like to be a hospitalized patient asked to wear a pair of unfamiliar, toy-like goggles). Currently there are not enough sham controls to really test the benefits of VR.
For pain management or opioid use disorders/ substance use disorders: ‘Helping helps the helper’
What’s cooking at HealthXL?
Join Chandana Fitzgerald, Chief Medical Officer @ HealthXL, and some of our members at the Nursing Opioid Hackathon @ Northeastern University on May 18th in Boston. As the nurses collaborate to identify innovative solutions to tackle the problem, there will be interesting and real-world insights from experts on opioid diversion, stigmas around the opioid crisis, roles of nurses on the frontline, and much more.
We’re giving five free passes to attend. If you are in the Boston area, give us a shout at email@example.com.
In other news, Guidewell Florida will conduct a series of sessions designed to understand, prioritize and collaborate on critical levers of the opioid crisis in Florida. By convening leaders, influencers, experts and stakeholders, we can become smarter together and better inform our individual and collective work. As a state and family of communities, it will be through close alignment and sustained collaboration that we will be able to stem this devastating crisis. We can make a difference through knowledge sharing and co-development of innovative solutions.
Stay tuned for more information on this series of events.
We’re also discussing all things opioids at the HealthXL Global Gathering in San Francisco in October. Interested in joining us? Check out event details here.