Oct. 02 2018

Opioid Challenge Applies Creative Thinking to a Crisis Situation

There has been no shortage of attention paid to the opioid crisis—the shocking statistics and devastating stories—yet solutions to the problem are still in short supply. In late September, Columbia Mailman School faculty participated in the Empire State Opioid Epidemic Innovation Challenge, a three-day competitive brainstorming session to generate ideas to address the crisis in New York and beyond.

Organized by the Consortium for Affordable Medical Technologies, a nonprofit based at Massachusetts General Hospital, and co-sponsored by the Columbia Mailman School, the event at Columbia’s Engineering School brought together government officials, scientists, and students for a series of panel discussions followed by a “hackathon.” Alan Batkin, co-chair of the Columbia Mailman Board of Overseers, served as one of the judges. Winning concepts included an online chat system to refer people to opioid recovery programs, a peer support system for those in treatment, and a nasal patch version of the naloxone antidote to prevent overdose.

Like much of the country, New York has been hit hard by the opioid epidemic. Between 2010 and 2015, the rate of deaths from opioid drugs doubled, while the rate of heroin deaths climbed five-fold. However, the worst may be over. In a keynote speech, New York State Lieutenant Governor Kathy Hochul said some progress is being made through programs that treat opioid deaths as a public health crisis. As chair of the Governor’s Task Force on Heroin and Opioid Addiction, Hochul developed policies like I-STOP that limits prescriptions for opioid painkillers from a month’s supply of pills to week. At the same, the state has expanded access to naloxone and launched a fleet of mobile units to bring treatment to opioid users in rural counties.

Developing these policies is more than a matter of responsible policy—for Hochul, opioid deaths are personal. She told how her nephew succumbed to heroin addiction after being prescribed opioids for injuring his hand in a meat slicer. A decade later, he sought out treatment but was turned away when his paperwork wasn’t in place. Soon after he was found dead with a needle in his arm. “I have embraced too many family members and strangers across the state,” said the lieutenant governor. “Nobody else should have to endure this.”

One of the areas of the state hardest hit by the opioid epidemic is Staten Island, where an overdose happens every day, and an overdose death every third day. In 2017, Silvia Martins, associate professor of Epidemiology and a prolific researcher on drug abuse prevention, contributed to a report on the opioid epidemic in the borough issued by the Staten Island District Attorney’s Office. The authors found that opioid addiction was experienced across races, ages, and socioeconomic backgrounds—not just the white affluent youth singled out in media reports.

At the symposium, Martins said more attention should be paid to prevention. The current opioid epidemic started as far back as the late 1980s when the pharmaceutical industry pushed primary care doctors to prescribe opioids for pain, but it wasn’t until a few years ago that the federal government started tracking prescription opioid use. We now know that a staggering one-third of American adults were prescribed opioid painkillers in 2015, alone, putting them at risk for misusing the medications. “While we’re seeing a decline in overdose deaths,” she said, “we’re still exposing a lot of people unnecessarily to these drugs.”

Later at the hackathon, Martins mentored two of the twelve teams competing for cash prizes: one that proposed a specially designed pill dispenser to prevent misuse, and another that recommended adding a chip to naloxone (Narcan) dispensers to report its geolocation to the local departments of health as the dispenser is used. “This [technology] would help planning for educational messages at the local level targeting close friends and family of people that overdose,” said Martins.

In a discussion on access to treatment, Pia Mauro, assistant professor of Epidemiology, spoke to the many ways stigma can prevent people from getting the care they need. For one, individuals may be reluctant to seek methadone treatment, which is only available through specialty treatment facilities. One answer is increasing access to buprenorphine, another medication to treat opioid use disorder that can be prescribed by physicians. “There is a strong evidence base supporting the use of medication to treat opioid use disorder,” said Mauro. “Medication saves lives.” Harm reduction can take other forms too, including naloxone, sterile syringes, as well as social supports like housing, employment—all aiming to “increase access to hope.”