Too Many Drugs, Too Little Data

This Tuesday, Aug. , ... ]

This Tuesday, Aug. , ... ] AP Photo

COMMENTARY | Unlike other states, Massachusetts leaders relied on data—crucial in developing policies, but too often not available—to guide their decision to begin allowing medication-assisted treatment for drug addiction in jails.

The road to tragic deaths from opioid abuse is clear. When sufficient care isn’t taken, prescribed opiates can lead to addiction, eventually leading users to cheaper alternatives like heroin and the synthetic opioid fentanyl. Overdoses of these drugs are too often deadly.    

Public officials are looking at all kinds of strategies to combat this plague, from better access to treatment to equipping first responders with life-saving naloxone to reverse overdoses. But while there is general agreement that this is a huge problem (about 47,000 deaths from overdoses involving opioids in 2017 from 19,000 a decade ago), the local answers for fighting drug addiction in particular communities can be obscured in a sea of inadequate, unsound or just plain wrong data. According to a 2019 Rand Corporation book that focused on fentanyl and other synthetic drugs, “the nation’s data infrastructure for monitoring and understanding drug problems has been crumbling.”

Even when good data does exist, it doesn’t reach the people who could put it into action. “Most states have prescription drug monitoring programs,” says Simon Kosali, associate vice provost for health sciences at the University of Indiana. “But there’s virtually no access to those data. . . there’s very little (information) that is national and current. It’s terribly frustrating.”

The Rand study indicates that some states are making solid progress and the CDC has just embarked on its Overdose Data to Action project, which has been designed, “to be able to do a number of surveillance activities to monitor and gather data about the scope and nature of the overdose problem,” according to a CDC spokesperson, LaKia Bryant,

Getting data in a timely way is also an obstacle. According to Rand’s book, “Treatment admissions data can lag by more than two years when it comes to releasing individual-level mortality data and seizure statistics. Such lags impede research and policy insights into this fast-moving problem.”

One complication in coming up with good data is that in half of the cases, there are multiple kinds of drugs involved, explains Chris Ruhm, a professor of public policy and economics at the University of Virginia, who has been studying this issue for ten years. “We don’t have any way to determine if there’s multiple drugs involved, whether [opioids are] the main drug involved,” he says. “It may not even be that there’s a conceptual way to tell.”

As a result, some states and localities are paying too little attention to other drugs, like methamphetamines, while they focus heavily on opioids. “At the obvious level,” estimates Ruhm, “we’re going to be understating the use of other drugs on the order of 20 percent.” When states, localities and the federal government fail to look at the right places to spend their money to diminish drug deaths, this kind of error can add up to millions of dollars spent less wisely than they could be.

There’s ample proof that adequate gathering and use of data can dramatically help to undermine the grip that opioids currently have in the United States.

As recently as five years ago, for example, Massachusetts was a laggard in such efforts. “We were very far behind,” says Dana Bernson, director of special analytic projects at the state Department of Health. “But we made the decision to get information in real time.”

Beginning in 2016, legislation was passed to use a health data warehouse to bring together data from across the state, looking at deaths by zip code, gender, ethnicity, age and so on. Armed with this information, steps have been taken. For example, there’s been a long-running debate about the benefits of weaning people from opiates of all kinds by using medication-assisted treatment with drugs like methadone, buprenorphine and naltrexone.

Massachusetts studied people with non-fatal overdoses, and compared those who received one of those medications aimed to eventually eliminate their addictions with those who didn’t. For half of the people who did receive one of those medications, deaths were cut in half.

This conclusion encouraged the state to change its policy regarding opiate abusers who wound up incarcerated. Traditionally, they would detox while locked up. But then, when they were back on the streets, many would automatically return to heroin or fentanyl, taking now potentially fatal dosages.  Compared to the rest of the adult population, data showed the opioid-related death rate was 120 times higher for persons released from Massachusetts prisons and jails, according to the Massachusetts Department of Health.

So, the state changed its ways, giving people who entered jail with substance abuse problems treatment drugs like buprenorphine instead of requiring them to go cold turkey.

In part as a result, the state, though still dealing with growing numbers of fentanyl-related deaths, has seen a decline in total opioid deaths, says Bernson. “The number of opioid-related overdose deaths in Massachusetts declined by about 6 percent in the first nine months of this year compared to the same period in 2018,” according to  a November 25 article in the Boston Business Journal.

The moral that we take from this: When embarking on an effort to solve many of societies’ maladies, don’t just speculate. Without timely data, your chances of success become slim.

Katherine Barrett and Richard Greene of Barrett and Greene, Inc. are columnists and senior advisers to Route Fifty.

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