The Most Important Part of the Opioid Crisis Isn’t What’s Already Happened; It’s What Happens Next

Updates about the Opioid Crisis in America have dominated news reports in recent years, and especially in recent weeks.

The final week of August 2019 brought two ground-shaking turns in the decade-long story:

  1. An Oklahoma judge ruled Johnson & Johnson, a pharmaceutical company, must pay the state $572 million as a penalty for its role in the opioid epidemic.
  2. Purdue Pharma, another pharmaceutical company closely linked to the opioid epidemic, is rumored to be considering a settlement that could total $10-$12 billion across over 2,000+ pending legal cases.

The dollar figures make headlines.

The blame game fuels debate.

What truly matters now, however, are the actions we take next.

The Oklahoma judge said the Johnson & Johnson penalty—which the company plans to appeal—should fund addiction treatment and overdose prevention, programs aimed at managing pain without opioids and other initiatives.

Past experiences in the tobacco industry indicate getting court-ordered dollars through the government machinery and invested toward the public good may not be straightforward.

But let’s assume hundreds of millions, if not billions, of dollars make their way through local, state and federal agencies. Where should the money go?

There’s little doubt investing in access to treatment for those already addicted will make a difference for some.

Reducing access to opioid painkillers, and increasing access to the overdose reversal medication, naloxone, could also be helpful. However, a recent study published by the American Journal of Public Health projected supply-side interventions and increased access to naloxone would reduce opioid-related deaths by only 10% in the next 10 years.

Times like these call for an ounce of prevention.

The vast majority of surgical patients receive opioids post-operatively. Nearly 10% become persistent opioid users. This holds true even today, despite everything we now know about this class of medications.

Meanwhile, certain innovative surgical providers and teams have adopted Advanced Surgical Pathways, including minimally-invasive techniques, shown to reduce the need for opioids by up to 90%!

Our recommendation:

  1. Comprehensive provider resources and training on the 21st Century approach to surgery and recovery. Make it the standard of care. Accept nothing less for public entity employees as well as Medicare and Medicaid beneficiaries. The rest of healthcare will follow.
  2. Patient education of this option in surgery. You should no longer expect a heavy dose of opioids post-op, with all of the side effects that come with it. There is a better way.
  3. Recognize and reward the providers who advance their practices. Implement public reporting and reimbursement strategies to draw attention to the innovators and leaders. Introduce an applicable Star measure in Medicare. Add a surgical pathway billing modifier for public and Medicare/Medicaid patients. Lead with the proverbial “carrot”. Reserve the “stick” as a last resort.

The coming years present a unique opportunity for policymakers, healthcare leaders, providers and patients to find a new way.

Let’s not waste it.

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