Speakers at an opioid symposium this summer at Columbia University Irving Medical Center challenged participants to reverse the crisis’s grim statistics. In the U.S., opioid overdose deaths have nearly quadrupled since 1999 to more than 64,000 per year, and they account for 20 percent of deaths in young adults. Yet according to the Department of Health and Human Services, just 20 percent of individuals with an opioid use disorder receive any kind of treatment.
Reducing opioid use and overdoses will take more research, most speakers emphasized. Already at Columbia and NewYork-Presbyterian Hospital, such work is getting underway. An opioid brainstorm session was convened late last year to foster collaboration among researchers at Columbia, NewYork-Presbyterian Hospital, industry partners, and the community—and led to the formation of working groups focused on prescribing and pain management, addiction treatment, community engagement, and bench-to-bedside research on pain and addiction. (The session was organized by Columbia’s NIH Clinical and Translational Science Award Program and overseen by the Irving Institute for Clinical and Translational Research, a partnership between Columbia and NewYork-Presbyterian.) The meeting coincided with other initiatives—including NewYork-Presbyterian Hospital’s efforts to monitor and alter opioid prescribing and to increase community-based treatment of addiction.
“With these groups, we’re hoping to spark new ideas and new collaborations about how to address the opioid epidemic,” said Muredach Reilly, MBBCh, MSCE, director of the Irving Institute, Herbert and Florence Irving Professor of Medicine at Columbia University Vagelos College of Physicians and Surgeons (VP&S), and an attending physician at NewYork-Presbyterian Hospital.
“We need research and solutions to address the many narratives underlying this crisis—overmedication of chronic pain, undertreatment of opioid use disorder, and systemic medical system, societal, and legal failures—in order to stop people from dying.”
The symposium coincided with the recent launch of the NIH’s HEAL initiative, a $500 million research program to fund interdisciplinary research on addiction and pain.
The participants discussed current approaches toward preventing opioid use disorder and overdose—and how to improve those approaches. Carlos Blanco, MD, PhD, director of epidemiology, services, and prevention research at the National Institute on Drug Abuse, said prevention needs to be a priority, not an afterthought. To do that, he said, more research about who is at risk is needed.
Patients who appear to be most at risk of death from opioid overdose and related problems are those being treated for chronic pain, according to research from Mark Olfson, MD, MPH, professor of psychiatry at VP&S. “Many of these deaths occurred in people who had been prescribed opioids in combination with benzodiazepines in the final month of life, showing us that we have a fair amount of work to do to improve the safety of pain management,” he said.
The crisis also has affected its victims in other ways that we are just beginning to understand. “A great deal of attention has been placed on the risk of overdose deaths following nonfatal overdoses, but our latest study showed that individuals who survive a nonfatal overdose are also at increased risk of dying from a number of medical conditions, including circulatory and respiratory diseases, suicide, and HIV,” said Olfson.
We need to be more aggressive about using MAT, which will involve overcoming numerous barriers.
For individuals with opioid use disorder, proven treatments are available but underused. Medication addiction therapy (MAT)—including naltrexone, buprenorphine, and methadone—reduces the risk of relapse, overdose, and mortality, said Frances Levin, MD, the Kennedy-Leavy Professor of Psychiatry at VP&S and chief of the Division on Substance Use Disorders at Columbia University Irving Medical Center/New York State Psychiatric Institute. But out of the 20 percent of individuals with opioid use disorder who get treatment, less than a third are treated with MAT. “We need to be more aggressive about using MAT, which will involve overcoming numerous barriers to using and prescribing these medications,” said Levin, who also is a psychiatrist at NewYork-Presbyterian.
MAT medications are often hard to access outside of major metropolitan areas, explaining one barrier. Patients also must remain abstinent for a week before one of the medications (naltrexone) can be used. To remedy these problems, Levin said that faculty at Columbia are working to expand implementation of MAT in community-based settings and to improve naltrexone induction. Other treatments, including opioid vaccines, game-based interventions, and phrenic nerve stimulation to reverse overdose, are also being developed.
Rural America garners much of the media attention on the opioid epidemic, but cities are also affected. Since the introduction of fentanyl to the New York City market a few years ago, someone in our city dies of an opioid overdose every seven hours, said Mary Bassett, MD, MPH, commissioner of the New York City Department of Health and Mental Hygiene.
New York City has been tackling the opioid crisis on a variety of fronts. Mayor DeBlasio committed $60 million to train 1,500 providers in MAT prescription, open syringe exchange sites in areas most affected by overdose deaths, and develop media campaigns to destigmatize addiction treatment. The investment also will expand the city’s Relay overdose response system, which positions wellness advocates in hospital emergency rooms to guide overdose survivors toward treatment. Bassett also reported that, following a directive from the mayor’s office, 960 pharmacies now offer naloxone, which reverses opioid overdose, without a prescription.
The symposium ended with two concurrent sessions and panel discussions. One session, led by Beatrice Ellerin, director of the Healthcare and Pharmaceutical Management Program at the Columbia Business School, focused on the industry response to the crisis; another, led by the Community Engagement Core Resource of the Irving Institute with NewYork-Presbyterian Hospital, Columbia School of Social Work, and the Washington Heights Corner Project, focused on community responses to the crisis.
In the months ahead, the Irving Institute and partners will continue to challenge and engage researchers, government, and industry and community leaders in tackling the opioid crisis through research and action. “By sparking new ideas and new collaborations, providing seed funding for initial steps, and empowering our working groups to respond to the NIH Heal Initiative and other funding opportunities, we will continue to work with our partners to facilitate research and implementation of science-based solutions to address the many facets of this national crisis,” concluded Reilly.