Guest MINDSETTER™ Rosenthal: Stepped-Up Emphasis on Prevention Essential to Fighting Opioid Epidemic

Guest MINDSETTER™ Rosenthal: Stepped-Up Emphasis on Prevention Essential to Fighting Opioid Epidemic

Over the past couple of years we have begun to make inroads in addressing and curbing the opioid epidemic in Rhode Island. The state of Rhode Island has seen some decline in overdose deaths and in the number of opioid-based prescription painkillers written annually. We will challenge to keep pace, however, unless further significant steps are taken.  

We have a moral imperative to make sure that all those who need treatment receive it and that addiction is de-stigmatized.  But most of all, we must do more to prevent people from becoming addicted in the first place. Once people develop an opioid-dependency, either on prescription pain-killers or heroin, their illegal street cousin, recovery is often difficult. Treatment-even high-quality evidence-based treatment--remains a hit or miss proposition.

A solid foundation for an expanded and comprehensive prevention effort has been established. Effective, common-sense measures championed by Prevent Opiate Abuse RI, among others, have become state law and they are beginning to make a difference. These measures include putting in place pill limits on the first prescription, mandating training in best practices in prescribing for all medical professionals licensed to prescribe opioids, requiring prescriber and patient have a crucial conversation upon first prescription of an opioid pain reliever to warn of risks of addiction and when appropriate discuss alternative treatments, and giving patients the tools to request partial prescriptions and the right to  indicate on their medical chart that they should never be prescribed an opioid.

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Now that the cornerstone has been laid, the citizens of our state require a comprehensive foundational approach to prevention and education.  This includes passing Senate Bill 143, sponsored by Senator Archambault and co-sponsored by Senators Sheehan, DiPalma, Paolino and Raptakis, requiring an additional conversation between prescriber and patient (and parents of a patient when a minor is being treated) upon third prescription or second refill with more emphasis on a discussion of non-opioid alternatives. While this approach is included in Health Department regulations it is not memorialized in the law.

Opioid prevention research demonstrated that as people move to 2nd and 3rd prescriptions the odds that they will be still be dependent on opioids one year later go up 50%.

We must make sure non-opioid alternative pain relief treatments are both affordable and adequately covered by health insurers. This same body of research shows that in most cases a combination of ibuprofen and acetaminophen, medications available over the counter, work as well or better than opioid-based pain relievers.  

There are times, when additional pain relief treatment is needed. Toward that end, we are developing a Non-Opioid Pain Relief Treatment Parity Bill modeled after the mental health parity laws for adoption and will unveil it soon.

In addition, it is critical that we do a better job of identifying those most a risk of addiction and intervene effectively. This includes expanding the use of S-BIRT in our schools, (Screening Brief Interventional & Referral to Treatment (S-BIRT). S-BIRT is an evidence-based tool that identifies those most at risk for substance abuse. We must couple the expanded use of this valuable tool with ensuring those designated most at risk receive counseling.

As responsible citizens, we have to demand that our public school's anti-drug curriculum is updated and fully funded so it is better designed to prevent students from abusing opioid-based pain relievers and heroin.. Rhode Island should also dedicate sufficient advertising dollar so that all of our residents understand the importance of emptying out their medicine chests and safely disposing of unused medications.   It is a known and accepted fact that a high percentage of young people have their first exposure to opioids from their parents’ medicine chests or from other family members and friends. 

It is not reasonable to believe we can will this epidemic to go away.  That is why the comprehensive approach we advocate is so important. Taken together, implementing these initiatives will prevent more wrecked lives and senseless deaths such of that of my eldest son Nathan who died of an overdose three years ago.

 

Josh Rosenthal, Ed.D, a leadership consultant and executive coach for Fortune 100 companies, is Chairman of the Prevent Opiate Abuse RI Advisory Board