Lauryn Saxe Walker, M.P.H., is a Ph.D. student in the Department of Health Behavior and Policy at VCU. In this article she discusses how her research impacts statewide health care policy surrounding opioid use.
Before I came to VCU, I worked in a medical intensive care unit in Baltimore. I frequently saw overdoses, withdrawl, alcoholic cirrhosis and infectious diseases from sharing syringes for injection drug use. Addiction was so clearly evident in daily medical practice, even a driving force behind many medical problems, but it was rarely addressed as a major health concern.
This is the perspective that drives my work now as a health policy researcher.
Addiction does not stop at the pill, drink or injection. There are a multitude of medical and social consequences and causes of substance use disorders that must be acknowledged if quality of care is to be improved and cost reduced.
The non-medical use of prescriptions drugs is not new. However, over the last decade, opioid prescribing practices increased for a variety of reasons. There was a genuine belief by many providers that opioids were not very addictive, there was a push to treat pain more aggressively, and there were some inadvertent financial incentives. Opioids became commonly prescribed by primary care providers, emergency physicians, dentists and a variety of specialists.
Unfortunately, daily opioid use can lead to dependence in as little as 8 days.
Eventually tolerance increases and more of the drug is needed to maintain sufficient pain control and/or avoid withdrawal symptoms. As people progress from dependence to addiction, they may move to heroin or synthetic opioids, such as Fentanyl. These stronger opioids have resulted in an increase in overdose casualties.
As of 2015, overdoses are now the leading cause of death for people under 50 in Virginia and the country at large, overtaking both gun-related deaths and car accidents nationwide. Virginia had more than 1,100 deaths and nearly 9,000 ED visits related to opioid overdoses in 2016.
As a health policy researcher, it is my job to study the issues that policy makers need to or are trying to address. Our department recently contracted with the state to evaluate the Medicaid Addiction and Recovery Treatment Services (ARTS) program. Through this evaluation, we are working with the Virginia Department of Medical Assistance Services (DMAS) which oversees the Medicaid program to identify implementation timelines, process barriers and data availability.
As a doctoral student, this has provided me with opportunities to work directly with state government officials as well as substance use disorder providers that are participating in the Medicaid program. The collaborative process is critical to producing relevant and accurate research. While we may see the data, providers and state officials can help us understand what may be missing from the numbers or what else needs to be investigated. Additionally, our findings must be presented in a way that is actionable for policy makers.
For instance, we have placed emphasis on identifying regional variation in treatment services. This allows officials to see where remaining problems may exist and what resources specific local areas may require. Our first report to the legislature can be found here.
Although targeted at a narrow population, the Medicaid ARTS program we are currently evaluating is a policy that acknowledges the growing need for attention to substance use disorders and integration into general care. Preliminary findings suggest that more people are in fact receiving treatment for their opioid or alcohol use disorder. Over the next 5 years, we will continue to monitor the effectiveness of these services and the program as a whole.
When people ask about “solving” the crisis, I would offer 2 points:
First, our current healthcare system is divided between physical health and mental health. Substance use disorders fall somewhere in between, so we need to bridge that gap to promote effective treatment. While people frequently present to the healthcare system with physical symptoms, places like emergency departments are often ill-equipped to deal with addiction-related issues. Delivery systems that can address the full-spectrum of health problems may be able to help reduce the opioid use disorder crisis.
Secondly, it is still difficult getting patients into effective treatment. This is in part because there is currently little consensus on what is “effective treatment” in the recovery community. Although there are some treatment guidelines, they are inconsistently practiced. Solving the current crisis will require practitioners from a variety of backgrounds, which historically have been very separate, to work together to reduce the number of people that fall through the cracks of the system.
For those of us in research, we also have a role to play. We have the tools to examine why a program, policy or treatment is or isn’t working. However, with that comes the responsibility to make sure information is shared beyond journals and conference to reach policy makers, providers and anyone that may translate our research into practice.
Research is how I’m contributing to the solution. However, there is plenty of room for all of us as students, clinicians, and community members to do our part.
If you are interested in being a part of research on substance use, mental health and student success at VCU, learn more about Spit for Science undergraduate and graduate research opportunities in a new interactive infographic.