PHILADELPHIA — The key issue in opioid abuse is that addiction thrives among populations marked by violence, homelessness and lack of employment, according to a speaker at Modern Healthcare’s Healthcare Issue Briefings. The topic of the briefing was seeking solutions to the opioid crisis using a population health approach.
“Here is the issue, I think addiction thrives in populations that do not,” David B. Nash, MD, MBA, FACP, dean of Jefferson College of Population Health at Thomas Jefferson University, said during the panel discussion. “That is the key issue. If they do not have jobs, if they do not have housing, there is violence. Sure, it is [the] doctor prescribing opioids. Maybe that is part of the central issue but, to us, it is addiction thrives in communities that are not thriving.”
David B. Nash
He added, “Disparities in income [and] violence, we view this as a population health crisis.”
Nash said health care providers need to locate “super utilizers” of opioids, look at care coordination and get more behavioral therapists involved with primary care. He said opioid abuse is a population-based challenge in which harm and opioid supply need to be reduced, and better training is needed to tackle the issue.
“I think we are medicalizing their problem, he said. “From a population health perspective, there is unexplained clinical variation in different practitioners’ approaches to pain and approaches to opioid use.”
Nash noted the population health tenant is that the feedback loop needs to be closed; educate; obtain data; determine the extent of the variation; and get into the emergency rooms. He noted that surgeons provide the medication, and then patients go back to primary care physicians who are not equipped to tackle addiction issues. Nash also cited a shortage of health care managers, behavioral therapists and primary care physicians needed to handle this issue.
He said the armamentarium to deal with pain is limited and contributes to the need to prescribe opioids.
“The overlay also is the quality of research on pain [and] the science of pain management,” Nash said. “Let us promote expertise in pain management and then close the feedback loop [and] reduce variation. Again, it is all about population health.” – by Monica Jaramillo
Nash DB. Seeking solutions to the opioid crisis: A population health approach. Presented at: Modern Healthcare’s Healthcare Issue Briefings; May 17, 2017; Philadelphia.
Disclosure: Nash reports he is on the board of Humana.