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This series of blogposts is based on multiple sources, links to some of which appear at the end.
The entire discussion on factors associated with opioid misuse rests on four factors: individual, interpersonal, community, and society. The individual is affected by outside factors and influences the outside factors. For example, an individual is exposed to trauma of any kind, uses opioid substances to get relief, becomes addicted, the family and friends are adversely affected at interpersonal level, the community loses a productive worker who would otherwise contribute financially and socially to it, and the society suffers when a sizeable number of individuals get trapped in this cycle.
The remedial measures must also include strategies for individual relief, interpersonal improvement, community uplift, and societal contribution.
Opioid Use Disorder – OUD – is the term which is now commonly used to describe this condition.
Health Resources & Services Administration – HRSA – a US Government organization is addressing the Opioid crisis in the following ways.
- Funding for Expansion of Treatment Facilities – They are funding several initiatives, expanding existing ones, and working towards comprehensive measures. Since September 2018, HRSA has awarded over 300 grants and cooperative agreement amounting to $173 million as part of the Rural Communities Opioid Response Program – RCORP. During the same time, it awarded $352 million in new funding to expand access to substance use disorder and mental health services at community health centers across the country. RCORP is currently funding and overseeing grant programs for planning, implementation, medication-assisted treatment expansion, and neonatal abstinence syndrome. HRSA supports testing evidence-informed interventions for integrating behavioral health with primary medical care. In August 2019, it awarded another $200 million for this purpose.
- Using Telehealth to Treat OUD – The Substance Abuse Treatment Telehealth Network Grant Program provided $700,000 for evidence-based telehealth programs and networks. There is a Substance Use Warmline where primary care providers can access expert clinical consultation to assist them in caring for patients with substance use disorders. HRSA’s Center of Excellence for Behavioral Health Technical Assistance offers opportunity to health centers to join a Community of Practice on best practices and strategies. They are also focusing on OUD in pregnant women and new moms so that they can access quality healthcare services.
- Connecting Stakeholders to Opioid-related Disorders – Their Rural Community Toolbox supports local action against OUD in rural America with funding, technical assistance, and other information. Through its ten regional offices, HRSA shares information, and connects stakeholders to take part in local, state, and federal opioid workgroups, taskforces, and meetings with various health departments, and tribal organizations.
- Sharing Best Practices – HRSA hosts webinars and regional events across the country that explore collaborative opportunities and ways to leverage expertise and resources to respond to the opioid crisis. HRSA supports the Guidelines for Health Supervision of Infants, Children, and Adolescents to provide healthcare professionals with updated background and recommendations for pediatric healthcare promotion, health supervision, and screening and assessing for substance misuse.
- Increasing OUD Training in Primary Care – Through the Health Center Program, HRSA provides extensive training and technical assistance to existing and potential health center grantees nationwide, including OUD treatment, and pain management. There are several other training programs for various categories of workers involved in OUD prevention and management.
- Informing Policy and Future Investments – HRSA supports to publish case studies and reports about opioid use and its treatment. With its support, the National Academy for State Health Policy released a report titled ‘State Options for Promoting Recovery among Pregnant and Parenting Women with Opioid or Substance Use Disorder’. There are several other instances of support for research and publications.
- Addressing Opioid-related Poisonings and Overdoses – HRSA awarded over $17 million to support all 52 organizations representing 55 Poison Control Centers. Children Safety Network is full funded by HRSA. The Rural Opioid Overdose Reversal Program Best Practices Guide summarizes the lessons learned from its program of the same name and supported overdose education and naloxone (antidote) distribution programs.
The opioid crisis management was handled at the legislation side also. Between 2016 and 2018, three laws were enacted by the federal government in response to the opioid crisis.
- The Comprehensive Addiction and Recovery Act (CARA) of 2016
- The 21st Century Cures Act
- The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act
Provisions in the above laws address the multifaceted aspects of the crisis with strategies aimed to reduce demand, supply, and harm.
The above are some of the measures, not all, taken by the US government to address the opioid crisis. However, it is a highly complex situation that has several multidimensional issues which require boarder and integrated approach prevention and treatment.
US is the largest economy in the world. It has the technical expertise and human/financial resources to tackle such large scales issues. In addition, the amounts awarded against pharmaceutical manufacturers and distributors is over $27 billion dollars. Most of this money will also be recovered and invested in prevention and treatment of OUD.
Pakistan situation is different. We neither have resources, nor expertise, nor the will to undertake such comprehensive issues. Substance abuse is a huge problem in Pakistan due to easy availability of hard substances such as heroin, ICE, and God knows what else. True, that we do not have oxycodone and methadone, and fentanyl is restricted, but we do have tramadol, tapentadol, pentazocine, and dextropropoxyphene as registered drugs. Tramadol has been put on controlled drugs list by India and they require additional documentation for import into Pakistan, but Pakistan still keeps it on free list. In addition, our drug regulatory mechanism is weak and fractured. It is important that the extent of dependence in our population is assessed fairly, and relevant measures be taken urgently to curb the tide. It would be naïve to assume that we do not have a problem with opioids. It is time to act, now.
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