While in the throes of a global pandemic, it is essential that we do not forget that there are other health crises dogging our nation. In fact, the United States continues to experience the worst drug addiction epidemic in its history3,7. Prescriptions were written, and deaths resulting from opioids each quadrupled between 1995 and 2010. By 2015, an estimated 92 million individuals in the United States were prescribed an opioid. In that same year, there were more than 33,000 deaths from an opioid-involved overdose4. By 2017, the number of national drug overdose deaths from opioids increased to 47,6008.
According to 2018 data from the U.S. Census Bureau, Florida is the third most populous state in the nation with an estimated 21.3 million residents, accounting for approximately 6.5 percent of the total U.S. population. Moreover, a 2017 executive order issued by Governor Rick Scott indicated that there were 3,900 opioid-related deaths in Florida in 2015. At the time, this represented 11.8 percent of the nationwide total, revealing a death rate nearly two-fold higher than the per capita estimate would suggest. In response, a statewide public health emergency was declared, opening up access to federal funding for prevention, treatment, and recovery services. Unfortunately, interventions to date have had mixed impact and efficacy, leading to disparate outcomes in patient care2.
As a leader in this area, NSU MD has adopted a multi-pronged approach, establishing a portfolio of innovation in physician training, community health interventions, and R&D, all of which reflect our stalwart commitment to dramatically improving Florida’s opioid addiction crisis and reducing its accompanying mortality rates.
We recognize that physician training is at the heart of addressing this crisis. Evidence shows there are wide variation and excessive dosage of opioid prescriptions for surgical procedures and
furthermore, that the system does not incentivize clinicians to recognize addiction risk at intake5,6,9. Furthermore, research shows there is a significant time delay between the onset of opioid use, often as many as 6-10 years, and the time when individuals seek treatment. This suggests a lengthy window of opportunity for identifying, engaging, and treating people much earlier in the disease trajectory than what is happening now6. Curricular innovation is needed so that the next generation of physicians is trained to reduce that window of opportunity.
In 2019, the State of Florida Department of Children and Families, Office of Substance Abuse and Mental Health, funded our NSU MD College to engage in the development and implementation of a longitudinal, integrated curriculum for substance use disorders under the P.I. ship of Daniel Griffin, Ph.D. The curriculum addresses pain and addiction pathways, pain management, the physician’s role, clinical and ethical decision making, biases, and health disparities. It incorporates novel pedagogies within a clinical context such as small group, case-based learning, simulation, telemedicine, and active learning. In this way, NSU MD pursues its Core values of curricular innovation, training our student physicians to identify, engage, and treat people much earlier in the disease trajectory.
In 2020, the Florida Blue Foundation funded its largest grant ever made to NSU by awarding NSU MD, Department of Population Health Science, funding for a four-year, longitudinal project to support the South Florida Community Coalition for the Prevention of Opioids and Substance Abuse in At-Risk Youth, which targets 3,590 youth, ages 11-18, in Broward, Palm Beach, and Miami-Dade counties. The mission of this program is to prevent youth opioid and substance abuse through a coalition dedicated to creating and implementing strategies such as innovative programs, awareness campaigns, youth summits, support groups, training modules, multimedia, and virtual platforms. These efforts will focus on our most vulnerable youth, including those who identify as ethnic and gender/sexual minorities (P.I. Julie Jacko, Ph.D.).
NSU MD also has numerous ongoing research and development efforts underway in the area of opioid and substance abuse. One project involves developing and evaluating interventions that provide measurable improvement inappropriate pain management to curb opioid dependency, opioid use disorders, and opioid misuse in Florida patient populations, with an initial focus on inpatient surgical procedures involving acute pain management. The effort strongly leverages our faculty’s vast experience in developing and delivering longitudinal substance use disorder curricular threads that highlight pain management and incorporate cutting edge learning methodologies. The project aims to: 1) derive new, actionable knowledge concerning at-risk behaviors of physicians and patients for opioid misuse; 2) identify key process indicators of opioid vulnerabilities within the inpatient surgical stay continuum of care and re-engineer the process accordingly; and 3) identify, design, deliver and evaluate interventions targeted at positively impacting physicians’ prescribing/practice behaviors.
Through these, and other ongoing initiatives, NSU MD is achieving its triple aims of education, research, and clinical service, ensuring that we are having a measurable impact on our nation’s grand challenges, like the opioid epidemic. Our commitment to addressing the opioid and substance abuse epidemic translates to a better prepared physician workforce, targeted community health interventions for thousands of Florida’s youth, and groundbreaking discoveries in pain management in clinical and surgical settings.
References
1Agency for Healthcare Research and Quality (AHRQ). (2019). Patient Safety Learning Laboratories: Pursuing Safety in Diagnosis and Treatment at the Intersection of Design, Systems Engineering, and Health Services Research. Accessed at https://psnet.ahrq.gov/resources/resource/31787/Patient-Safety-Learning-Laboratories-Pursuing-Safety-in-Diagnosis-and-Treatment-at-the-Intersection-of-Design-Systems-Engineering-and-Health-Services-Research-R18, August 6, 2019.
2Godlee, F., & Hurley, R. (2016). The war on drugs has failed: doctors should lead calls for drug policy reform. BMJ 2016;355:i6067. Accessed at https://doi.org/10.1136/bmj.i6067, 8/9/19.
3Gostin LO, Hodge JG Jr, Noe SA. (2016). Reframing the opioid epidemic as a national emergency [published online August 23, 2017]. JAMA. doi:10.1001/jama.2017.13358
4Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. (2017). Prescription opioid use, misuse, and use disorders in U.S. adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017;167(5): 293-301.
5Hill MV, McMahon ML, Stucke RS, Barth RJ Jr.(2017). Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg. 2017;265(4):709-714.
6Hser, Y., Evans, E.M.A., Grella, C., Ling, W., & Anglin, D. (2015). Long-term course of opioid addiction. Harvard Review of Psychiatry, 23(2):76–89.
7Kolodny, A., & Frieden, T. (2017). Ten Steps the Federal Government Should Take Now to Reverse the Opioid Addiction Epidemic. JAMA, 318(16), 1537-1538.
8NIH NIDA: National Institutes for Health National Institute on Drug Abuse (2019). https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Accessed 8/7/2019.
9Shah A, Hayes CJ, Martin BC. (2017). Characteristics of initial prescription episodes and the likelihood of long-term opioid use—United States, 2006-2015. MMWRMorb Mortal Wkly Rep. 2017;66(10):265-269.