IOC Urban Seminar: Cities and the Opioid Crisis

The IOC kicked off the Spring Urban Seminar Series this past Tuesday with a panel discussion on the growing opioid epidemic in cities, particularly in Massachusetts. Despite an increased public focus on addiction prevention, treatment and recovery, the number of victims and affected persons remains high and continues to climb. What progress, if any, has been made on this issue? What kinds of policies are cities and towns, police departments, and medical personnel taking to prevent addiction and treat those who suffer from it? And finally, where and how should we make changes to stem and reverse the rise of those suffering from opioid addiction?

Moderated by Boston University (BU) School of Law Professor Jack Beermann, panelists included:

  • Leonard Campanello – Chief of Police, City of Gloucester, MA
  • Colleen LaBelle – Program Director, State Technical Assistance Treatment Expansion Office Based Opioid Treatment with Buprenorphine, Boston Medical Center
  • David Rosenbloom – Professor of Health Policy and Management, BU School of Public Health and Former Commissioner of Health and Hospitals for the City of Boston
  • Jennifer Tracey – Director of the Office of Recovery Services, City of Boston

Opioids are not a new problem, but—as Beermann and the panelists pointed out—the issue has only recently been gaining significant traction in the public eye, particularly as the epidemic impacts white and suburban populations. Many, including our panelists, attributed this demographic shift to the over-prescription of opioid drugs to treat pain. Ironically, minority populations have been chronically undertreated for pain, and the rate of opioid overdose in those demographics have steadily decreased since the 1980s.

Meanwhile, the approach to confronting opioid abuse has departed from the previous ‘war on drugs’ mentality. “Once white middle class America started having problems,” said Beermann, “it turned the narrative from prison to more therapeutic methods.” This change from incarceration to treatment and recovery cannot be divorced from underlying influences of race and class, but the way in which governments and public health and safety professionals respond to addiction has undoubtedly changed.

Both moderator and panelists agreed that education and access should be the primary goals of addiction, recovery and treatment programming over more disciplinary measures. Panelists identified the changing ways their organizations and institutions are handling opioid addiction:

  • The War on Drugs is over. Gloucester Police Chief Leonard Campanello reclassified the War on Drugs as the “war on addicted persons” and praised new methods of policing, where police stations have become a safe zone for addiction sufferers. The Angel Initiative, started by Gloucester PD, lets police become “part of the discussion, and do work that is typically reserved for more social work institutions,” by pairing patients with treatment centers immediately and following them throughout treatment.
  • Boston Mayor Martin Walsh’s recently unveiled Office of Recovery Services (ORS) is the first municipal office solely focused on addiction recovery services in the country. “Our best asset is our partnership program,” said ORS Director Jennifer Tracey. Creating programs like PAATHS (which provides referrals, information and support to approximately 25-50 people daily) and developing strategic partnerships with hospitals, community health centers and organizations like Boston Healthcare for the Homeless has drastically increased education and access to addiction care in Boston.
  • Collaborative care. “We’ve been dealing with this for a long time,” said Colleen LaBelle, who helps lead opioid treatment initiatives at Boston Medical Center (BMC), “but the medical community hadn’t treated addiction before.” Identifying holes in the system was LaBelle’s first mission. She has since created wrap-around services that increase training for medical personnel, placing a particular focus on nurse training, and opens lines of communication with other providers before and after any hospital visits. BMC has seen their rates of ER visits and hospital admissions for opioid related incidents cut in half due to the success of these programs.
  • Public policy solutions. Professor David Rosenbloom startled the room when he revealed that despite accounting for only about 5% of the world population, the U.S. uses over 80% of the world’s pain medication. He focused on the overuse and misuse of pain medication and advocated for accountability on the part of institutions—like the pharmaceutical industry and healthcare professionals—but recognized that sometimes doctors are caught between a rock and a hard place. “Doctors are rated on how they manage patient pain so it becomes a sanction against them when they don’t deliver.”

Questions from attendees also focused on how to increase education to prevent addiction, and create change in institutions that are not performing.

  • Adolescent education. Campanello championed programs that provide prevention education to parents with kids in sports: “It’s just like concussion education,” he explained. Doctors are slowly learning that opioids shouldn’t be the first solution. “Young people’s brains aren’t developed and they have a 67% chance of developing an addiction from medication they got from their doctor,” he said.
  • Medical professional education. An attendee who works as a doctor at Massachusetts General Hospital and Boston Healthcare for the Homeless demanded more opioids training for physicians. “We don’t get any,” she said. Opioids and surgery should be a last resort. To fill in the gaps, she uses mytopcare.org, which trains doctors, pharmacists, and patients to address pain without opioids.
  • Campaigns to prevent and treat. A statewide program, State without StigMA, works to remove negative stereotypes that create barriers for people with addiction. “Addicts already self-stigmatize so they need the help,” said Campanello. Nonprofits like Learn to Cope offer support for friends and family of those suffering from addiction. “If you’re looking to identify symptoms or you just want to help, that’s a start,” said Tracey.

Looking ahead, all panelists agreed that bringing more people to the table to find solutions—not only on the ground but in the legislature—is essential to solving the opioid problem.

“Pharmacists are an underutilized resource,” said LaBelle. “They’re trained but are used basically like cashiers.” Brigham and Women’s Hospital and the Massachusetts College of Pharmacy are two institutions looking to be part of the conversation. “There is absolutely a potential role,” said Rosenbloom.

Regulation is key, closed Campanello. “We need to be smarter with how we use and distribute narcotics and that’s on the pharmaceutical companies, the FDA, and the legislature.”

To revisit this Seminar, tune in via the livestream feed below.