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Crowdsourcing ways to reduce America's drug overdose crisis

Yale Medicine Magazine, 2017 - Autumn


As overdose deaths accelerate, Sten Vermund, M.D., dean of the Yale School of Public Health, loudly vents his frustration over restrictions on prescribing Narcan, an effective, easy-to-administer opiate overdose antidote.

“I am so sick and tired of the lack of access to Narcan in our community,” he says. “I feel like it is ridiculous that Narcan is not over the counter.”

Vermund then announces that he will write 300 prescriptions for Narcan and give them to people willing to distribute the antidote throughout the community. He also vows to work with the Yale School of Law and pressure the Food and Drug Administration to widen access.

Moments later Vermund is led off in handcuffs, one of many doctors nationwide being arrested for flouting prescription rules governing Narcan.

But Vermund and others have made their point and inspired action, a commentator says. Pop-up Narcan distribution networks proliferate, sparking talk of vending machines to make the antidote even more easily available. Happily, pharmacists can provide Narcan liberally in Connecticut, but this is not true in many other states and cost is still a major barrier.

The dramatic scene never happened. It was a role play done at a Nov. 29 pitch & solve sponsored by InnovateHealth Yale and Dwight Hall to brainstorm solutions to the state’s exploding opioid addiction and overdose crises. More than 50 people—from Yale doctors and Ph.D.s, to lawyers to activists to recovering addicts—attended. They were presented with specific problems related to the crisis and asked to formulate solutions that they then presented to the full group.

“This is a rare opportunity to bring together the Yale and New Haven communities to solve a problem that directly affects all of us,” said Onyeka Obiocha, director of innovations at Dwight Hall.

The statistics tell just how serious the problem is. Lauretta Grau, Ph.D., a research scientist at the Yale School of Public Health, who researches opioid-involved deaths in Connecticut, laid out the grim statistics. State opioid-involved deaths have skyrocketed from 300 to 400 in 2013-14 to 700 to 888 last year, she said. This year they will exceed 1,000, she said. The appearance in recent years of illicitly manufactured Fentanyl and similar compounds, 50 to 100 times more powerful than heroin, has made the problem even worse, Grau said.

The demographics of the opiate addiction have also changed, Frederick Altice, M.D., a professor of epidemiology at the Yale School of Public Health, told the attendees. “It was mostly an urban problem of people of color,” Altice said. “It has now become suburban, rural, and (affects) increasing numbers of Caucasians.”

Altice, Grau and Bacheer Arnaout, M.D., challenged the group to come up with solutions to a variety of specific challenges, including increasing access to Narcan, clean needles, and treatment options; reducing the stigma faced by those addicted to opioids; assuring treatment for HIV and hepatitis C and overcoming insurance and other barriers to drug treatment.

“This is an epidemic that is increasing like there is no tomorrow,” Altice told participants. “We really need very creative innovative ideas about how to tackle this in real time.”

After a period of reflection, the teams of about six each presented ideas that ranged from safe injection rooms to harnessing technology to public awareness campaigns.

Representing his group, Will Maher, a student at the Yale School of Public Health, suggested that Facebook could be enlisted to point people toward treatment and other services. If someone searches for "opiate" or "Narcan," ads for treatment could appear. He took the idea step farther, suggesting a mobile phone app that provides opiate users with information on everything from needle exchanges to treatment options.

Yale School of Public Health Professor Robert Heimer, Ph.D.’s group took on preventing opioid deaths by suggesting free Lyft rides to safe 24-hour injection rooms. On-site staff could assist overdose victims immediately, saving lives, while the rooms could also serve as clearing houses for information and services, he said.

Another group focused on reducing the stigma associated with opiate addiction that often prevents people from seeking help. Rachel Schmidt, who runs a group called Music Intervention, called for a public awareness campaign to make people understand opiate addiction can touch anyone. “Our idea is to de-stigmatize,” she said. A vital part of that effort would be to listen to and incorporate voices of those who have experienced addiction, she added.

Beatrice Codianni, executive director of SWAN (Sex Worker Allies Network), an organization that advocates for sex workers, is just such a person. A recovering heroin addict, Codianni said that input from those who have lived through opiate addiction is vital to any effort seeking to address the problem.

“You really need to bring those of us who have that knowledge and that experience to share with you,” she said. “You can listen to us and maybe learn something. I think that’s really important.”

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