States, Cities Looking for Best Ways to Attack Epidemic

By Chris Adams

For Dr. Jay Butler and his peers in the public health community, the opioids epidemic has taxed states in dramatic ways. And they’re still trying to determine the best way to counter it.

As director of the Division of Public Health in the Alaska Department of Health and Social Services, Butler has seen a steady increase in the number of deaths tied to opioids in his own state.

And as immediate past president of the Association of State and Territorial Health Officials, he talked with his peers who were witnessing an exponential increase in deaths tied to different opioids. Among synthetic opioids other than methadone, the increase has been stark: a six-fold increase in the death rate in just four years from 2012 to 2016.

“There is no part of North America that has not been impacted,” Butler said.

In a session with journalists at a National Press Foundation program, Butler detailed what officials in Alaska have done – including declaring an official state of emergency about the epidemic – and then discussed strategies at play around the nation.

“This is not like smallpox eradication, where we had a vaccine,” he said. Instead, the strategies to combat it are many – and there is political and cultural resistance to employing some strategies that public health officials consider effective.

He detailed three levels of prevention:

The first seeks to reduce the need to self-medicate and tries to control access to addictive substances. One strategy is to change physicians’ prescribing practices.

The second level employs screening and treatment for people battling addictions – and seeks to remove the stigma often associated with getting such treatment.

The third level intervenes at the crisis stage, aiming to save lives by, for example, making the opioid antidote naloxone widely available.

His presentation also detailed what success in this effort might look like. In the next three years, the hope is to see fewer deaths from drug overdose, as well as declines in car crashes tied to the drugs. Down the road, the hope is to see lower rates of drug use in general, as well as lower rates of violence, crime, child neglect and the myriad social ills that follow the drugs.

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