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COMMENTARY What's working in the opioid epidemic

Observer-Reporter - 7/1/2018

When defining successes in my field, the answers are often vague and abysmal. Some treatment centers boast of outrageous success rates, but more realistic evaluators will tell you 30 to 50 percent is outstanding.

In any other walk of life, this is a failing grade. However, success in the world of substance use disorder treatment is the subtle art of attempting to measure the absence of something. When someone doesn't die, when someone doesn't return to treatment or to jail, do we call that success by default? Conversely, if someone is admitted to treatment, or completes a treatment program, is that a success?

Perhaps most complex is the paradox that occurs when someone returns to treatment instead of dying or committing a crime, losing family or a job. Yet, we still deem this a failure.

So, to measure success is to capture the absence of something across an always-moving, often-transient target with no real agreed-upon definition of what the word actually means.

Asking what's working is perhaps a better way to get at the heart of the "success" matter.

In a word, my response is: collaboration.

Washington County has been referred to as "Recovery Town" due to the many resources we have for those seeking to be treated for substance use disorders. What is often less visible is the work many key stakeholders are doing behind the scenes. They include politicians, emergency department directors, health-care professionals, police, SUD and prevention leaders, mental health providers, faith-based leaders, corrections, probation and parole officers, the courts, survivors and relatives of those who weren't so fortunate. This group is unprecedented as a county entity.

They have all come together with the help of the University of Pittsburgh's School of Pharmacy Education and Resource Unit, Technical Assistance Center (TAC) to form the Washington County Opioid Overdose Coalition. With the help of TAC, this group has developed a three-year strategic plan that is being deployed through the efforts of five subcommittees focused on carrying out key objectives throughout the county.

Washington County is one of only a handful of counties that not only didn't see the average increase of 25 to 30 percent in overdose fatalities, but actually experienced an 11.6 percent reduction in such fatalities.

Several of the initiatives outlined by the plan and deployed by the subcommittees have had a contributory effect on that statistic.

Availability of Narcan is the most tangible of these. We know that without the availability of this life-saving antidote to overdose, at minimum an additional 336 residents would have died needlessly in the last two years.

Increase in treatment initiation is another factor to point out. The Washington Drug and Alcohol Commission saw an increase of 50 percent more individuals referred to treatment last year. Furthermore, two Centers of Excellence became operational in the key areas where overdose deaths occur in the county. They were also able to steer several hundred individuals into treatment, and those individuals who entered treatment have benefitted from ongoing support and early intervention if their condition again began to deteriorate.

Stigma reduction in law enforcement and health-care settings have increased the number of individuals struggling with SUDs being referred directly from the county's three hospitals to treatment.

Coordination with all aspects of the criminal justice infrastructure has expanded and increased during the past year, and more officers and officials involved in this crisis are stepping forward and looking for alternatives to incarceration that have evidence-based outcomes to break the cycle of addiction and recidivism.

Educating the public at large and especially those at high risk of overdose and their family members makes the availability of Narcan possible and practical.

Effective today, the tool that all SUD professionals use to diagnose and place individuals in treatment facilities is being transitioned statewide to a nationally recognized set of criteria. The goal is to further individualize treatment to create more effective programming based on the individuals' specific needs. As those needs change, this tool is better able to move patients through a full continuum of care that is geared to produce better outcomes. Specifically, fewer deaths, less instances of parental rights being terminated, lower recidivism rates and an increase in those entering recovery from a variety of pathways.

As a county, we continue to evolve strategically to better combat this problem. It has been documented that for every person who suffers from a substance use disorder, there are as few as four and as many as 16 people who have been affected. According to the National Survey on Drug Use and Health, for every overdose death, there are as many as 108 people who meet criteria for dependence. This means that far more of our residents are being affected than many consider. With the stress that SUDs collectively place on our systems, the cost is indeed staggering. We have seen substantial increases in criminal cases, children and youth placements and emergency room visits all directly related to increase use of substances.

We must remain committed to following the numbers, measuring along the way that the initiatives we are deploying are making an impact and being open-minded to changing our approach as new information becomes available and new trends are identified. Most importantly, we must continue to work in collaboration with each other. No longer will system barriers be tolerated considering the urgency this problem presents.

The etiology of becoming an addict or developing a substance use disorder is varied, and no single model or theory has been proven to be 100 percent accurately predictive. Many factors have been identified as risks. The work that is being done by the local leadership mirrors this pattern on the solutions side of the equation. In a strange sort of parallel, they overlap and intertwine in the same ways that the risk factors for developing a substance use disorder do. In this respect, we are fighting fire with fire, on a multifaceted front.

As more patterns are identified and emerge as real-time data and statistics, analysis leads to actionable strategy that lets us move with this epidemic and will eventually allow us to get in front of it. The goal is to eliminate overdoses. Identifying and expanding upon what is working is the focus. The initiatives of the Washington County Opioid Overdose Coalition are making a difference. They are working.

Erich Curnow is director of Clinical and Case Management Services at Washington Drug and Alcohol Commission.