On the evening of August 31st, the Zakim Bridge, one of Boston’s prominent landmarks, glowed in purple in honor of the National Overdose Awareness Day. This was the second time in its history the bridge was lit in purple, the first time being right after the passing of rock star Prince. Since the Center for Disease Control and Prevention (CDC) issued an official warning earlier this year against overuse of prescription pain killers, the magnitude of the opioid epidemic in America has garnered greater public attention. Unfortunately, the situation is rapidly worsening with no viable solution in sight.
According to the CDC, more than 240 million prescriptions were written for opioids in 2014, enough for every adult in America to receive a bottle of pills. Such excessive use of opioids has contributed to a sharp increase in opioid-related addiction and overdose. From 1999 to 2014, annual opioid-related deaths, which used to be generally associated with illicit drugs such as heroine, quadrupled to nearly 30,000. Newer data also suggests that the rate of opioid-related mortality is rapidly increasing.
The CDC estimates opioid abuse and addiction to cost $55 billion per year. Earlier this year, the federal government enacted new opioid legislation in the hopes of taking initial steps to address some of the problems, but funding concerns and limited scale have raised doubts on its potential effectiveness. The State of Massachusetts has been the first state to pass a comprehensive bill to fight the epidemic, but the bill’s attempt to leverage the current healthcare system to treat and manage patients with both long and short-term opioid issues might prove too overwhelming for the system.
A better solution
Treating opioid addiction is a complex process involving saving patients from overdose in the short-term, but more importantly helping them stay sober over their lifetime. Just as people struggling to fight obesity must address their social and emotional circumstances of long-term eating and lifestyle habits, people with opioid addiction also need to deal with social and emotional circumstances of addiction to avoid relapses. Unfortunately, the current health system, including most rehab facilities, is not well equipped to deal with such long-term issues. Today, the medical community cannot even agree on which treatment methods are the most effective. Some advocate that drugs are the key to change long-term addiction, but skeptics question whether drugs are effective at changing behaviors. The best ideas to combat opioid problem have not even considered the myriad of social and emotional issues that are inherent to addiction.
In The Innovator’s Prescription, Clayton Christensen, the co-founder of the Christensen Institute and architect of the theory of disruptive innovation, explains that when there are no precise diagnostics or understanding of the causes of a disease, the disease should be treated in a solution shop hospital. There, the problem is addressed in an integrated way to diagnose the root cause and prescribe the best possible course of therapy based on experts’ opinions. Unfortunately, the current solutions for opioid abuse patients are based on products (e.g. drugs) or services (e.g. emergency department) that are modularized so that healthcare providers are unable to follow up and manage long-term patient recovery. These piecemeal solutions have not only failed to prevent relapses and continued abuse, but also contributed to increasing costs of care. For example, as the number of opioid-related deaths has quadrupled over the past 15 years, the price of naloxone, a drug that can instantly reverse the effect of overdose, has more than tripled over the same period. Before the EpiPen controversy can subside, another major drug price controversy is already brewing.
The Opioid Abuse Center of Excellence (OpACE)
Following Clayton Christensen’s recommendation for dealing with conditions that do not have standardized treatment processes, we propose a stand-alone solution shop hospital for opioid addiction and overdose—let’s call it the Opioid Abuse Center of Excellence (OpACE). OpACE would not only treat opioid patients more effectively, but also off-load the burden from the existing care facilities, many of which are already overloaded.
OpACE would be located near major emergency departments where acute and chronic opioid patients come in for help. Under this model, all patients whose primary health issues are based on opioid abuse would be triaged to OpACE where they would receive specialized care from opioid experts, mental health specialists, and social workers. Centers like OpACE would also focus on creating a community that can serve as a long-term support network for addiction recovery and prevention. These centers would develop a standard of care for patients at various stages of addiction and serve as voice of authority on proper opioid use and management.
There are several advantages to this model. First, opioid abuse patients would get critical help they need without burdening the existing care facilities such as emergency departments (ED). The ED remains the bottleneck for hospitals, and opioid abuse patients only contribute more to the traffic jam. Centers like OpACE could help to relieve this problem.
Second, OpACE could provide an integrated treatment service for both acute overdose patients and those struggling with long-term chronic addiction. The center would address all health issues relating to opioid misuse and addiction, including education. Doing so would have multiple benefits. For example, having a dedicated facility where all opioid issues are addressed together would save both time and funding. Additionally, OpACE could provide long-term solutions that the current system cannot since it would integrate medical care facilities, rehab facilities, mental health services, and social services all under one roof (currently, there is no such facility or service available).
Lastly, a centralized system is the fastest and most efficient way to establish a standardized protocol of opioid abuse treatment among the medical community, the government, and social programs. We need all experts in opioid abuse treatment to be able to come together to debate and share their views. Centers of excellence would integrate these views much faster than trying to push ideas via existing channels that are disparate and already too complex.
If we tried to address the opioid epidemic by simply limiting access to prescription pain medication, we would fail to properly address some of the core causes of the epidemic that are rooted in social and emotional issues. A center that could provide comprehensive long-term solutions is the answer to combatting the challenge more effectively. To date, our health system has been ill-equipped to handle such complex issues, which consequently has contributed to an unnecessary rise in the cost of care. By creating a dedicated center that can become an “expert” environment and community for opioid abuse and recovery, we can not only curb the rising cost of care, but also find effective solutions for fighting the dark clouds of the epidemic.