T

he spiral of opioid addictions and overdoses is unrelenting. But there are bright spots all across the country: Men and women working in classrooms and courtrooms, in private labs and public offices, in clinics and on the street — all trying to find the next big way to save lives.

STAT has identified 12 potential game changers that could begin to bend the curve of the opioid epidemic. Some of these are experimental ideas, not yet subjected to rigorous clinical trials or peer review. But they’re intriguing enough that public health experts and addiction counselors are eager to learn more.

THE SCIENTIST: Gary Matyas
Chemist Gary Matyas is working on a vaccine to help heroin users stay off the drug. It works, at least in theory, by tricking the immune system into thinking the heroin is a foreign invader. The system then releases antibodies that attack the heroin, blocking it from getting into the brain. That makes it much harder to get high, which (again, in theory) can help break the cycle of craving and withdrawal. “It gives a window to an addict who wants to overcome addiction,” said Matyas, a chemist at the Walter Reed Army Institute of Research in Maryland. One shortcoming: The vaccine is specific to heroin, so recovering drug users would still need access to medication-assisted treatment to combat cravings for other opioids. Kim Janda, a chemist at the Scripps Research Institute in California, is developing a similar vaccine for heroin, as well as vaccines for various synthetic opioids. Both chemists have seen early success in animal testing, and both believe their findings could lead to a clinical trial within two years. All they need is the money — they’re each trying to find up to $5 million — to get such trials off the ground.

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THE COMMISSIONER: Dr. Leana Wen
More than 600 drug users died in Baltimore last year. It could have been far worse. Since taking office in 2015, Health Commissioner Dr. Leana Wen has issued a blanket naloxone prescription so that all Baltimore residents trained in using the overdose antidote can get it. Her department has also trained 20,000 residents to revive overdose victims. And she’s launched awareness campaigns that reflect urgency of the crisis (one is aptly named “Don’t Die”). An emergency physician, Wen discusses opioids with doctors on grand rounds and is pushing for programs like a 24/7 emergency center to get drug users into treatment in their exact time of need. Focused as she is on solutions, she’s also unafraid to speak truth about the crisis in her majority-black city. “We have to be honest about structural racism: The reason why this is suddenly a national crisis is white people dying in suburban and rural areas,” Wen said. “There’s been a sea change in seeing addiction as a disease, but this is not new for us in Baltimore.”

THE INTERVENTION: Public naloxone boxes
Dr. Geoff Capraro has seen far too many preventable overdose deaths in Rhode Island. He wondered why the antidote naloxone isn’t more readily available in public places like cardiac defibrillators. So Capraro, an assistant professor of emergency medicine at Brown University, is taking action. He’s installing nearly 50 naloxone boxes at community organizations and treatment centers in Providence. “The biggest impact will be the message,” Capraro said. “This gives a bystander the best chance to save their neighbor.” The city of Cambridge, Mass., is testing a similar idea, with locked, temperature-controlled boxes that could be set up outdoors. Bystanders who see an overdose in progress would call 911, receive a code to unlock the box, and revive the victim. First responders would follow right behind. “This is a surrogate for EMS,” said Dr. Scott Weiner, an emergency room physician at Brigham and Women’s Hospital in Boston. “But we don’t want to replace EMS. It’s a highly teachable moment.”

THE PROSECUTOR: Eric Schneiderman
Insurers are one of the biggest roadblocks to getting addiction treatment. Eric Schneiderman, New York’s attorney general, wants to change that. He successfully pressured insurance giants Cigna and Anthem to end requirements that doctors obtain “prior authorization” before getting patients into medication-assisted treatment. The process often took days — during which people hoping to quit drugs fell back into addiction. “Getting people into treatment faster, and when the window of opportunity is open, is vital to stemming the opioid addiction crisis,” Schneiderman said last year. The American Medical Association has urged other state attorneys general to fight for similar settlements. “There is no medical, policy, or other reason for payers to use prior authorization for MAT,” CEO Dr. James Madara recently wrote in a letter, “and we hope that New York’s efforts will be the first of many similar ones across the nation.”

STAT forecast: Opioids could kill nearly 500,000 in U.S. in next decade


THE CYCLE BREAKERS: PATHways
This scrappy Lexington, Ky., clinic has provided expectant mothers opioid addiction treatment alongside prenatal care since 2014. “The program gives them hope to be a mother, and to be present for their children,” said Kristin Ashford, assistant dean of research with the University of Kentucky’s nursing school. So far, more than 150 pregnant mothers have received medication-assisted treatment — something that’s hard to come by in a region lacking evidence-based options — as well as counseling and peer support. In a judgment-free environment, professionals work with mothers to reduce their risk of harming their children and give them tools to create stable homes. “We’re all fighting for the same thing,” said Jason Joy, a substance abuse counselor at PATHways, which is run by UK Healthcare. “Long-term sobriety and a shot for the next generation.”

THE EDUCATOR: Dr. Martin Klapheke
Dr. Martin Klapheke is well-aware that too many doctors overprescribe opioids for pain. His answer: revamping the curriculum at the University of Central Florida’s College of Medicine, where he’s an assistant dean. Education about opioids is now woven through the curriculum. Students learn about substance use disorders in their first year. On their pediatrics rotation, they observe the tremors, seizures, and incessant high-pitched wails of babies born with opioids in their system. They role-play talking to patients about alternative pain management. And they hear from psychiatrists about how to use medication to help patients try to break the grip of addiction. The curriculum is so well-regarded, UCF is now sharing it with eight other Florida med schools. “It’s going to take time for the culture to change,” Klapheke said. “I’m hopeful there will be a sea change.”

THE INSURER: Cigna
Last fall, insurance giant Cigna pledged to cut its customers’ opioid use by 25 percent over a three-year period. The company started with its doctors — more than 82,000 of them. They are shown reports explaining how their prescribing stacks up against their peers — and they’re encouraged to seek out advice from those peers on best practices to taper patients off painkillers. “Physicians can see how they’re doing,” said Dr. Doug Nemecek, Cigna’s chief medical officer for behavioral health. “They can take action. They can take care of patients. They can learn from each other.” Cigna is already halfway to its goal.

THE DRUG DESIGNER: Inspirion
Drug users cut, crush, and grind prescription pills hoping to get high. So the FDA has urged companies to make such abuse more difficult. This past spring, Inspirion became the first drug maker to be allowed to market an opioid’s “abuse-deterrent” properties. The company touts its immediate-release oxycodone tablet, marketed as Roxybond, as having inactive ingredients that are “more difficult to manipulate.” And even if these pills are broken, Roxybond’s “viscous material” makes it resistant to passing through a needle. Dr. Jeffrey Gudin, director of pain and palliative care at Englewood Hospital in New Jersey (who works with Inspirion), has said in a press release the tablet can “offer clinicians a new approach for treating patients in pain while also fighting against the potential for abuse.” And, with nearly 18 million patients in the U.S. alone getting oxycodone each year, more formulations of this kind are likely to follow.

THE POLICE: Ross County Post Overdose Response Team
Every Wednesday, officers and addiction specialists in this Ohio county review the past week’s overdose incidents. Then they fan out to knock on the doors of those who have overdosed. “We provide them literature and a counselor. If they want immediate help, we can link them to detox or treatment programs,” said Chillicothe Police Detective Bud Lytle. So far this year, police have visited nearly 170 homes and talked to drug users or their family members at about half of them. Ten have gone into treatment. The program has changed the way people with addiction view authorities: “Individuals are hugging us,” Lytle said. “Some people say: ‘You’re cops, you should lock people up.’ But I took an oath to do everything I can [to save lives]; we’re going to do whatever it takes, even if it’s not traditional law enforcement efforts.”

THE ACTIVIST: Gary Mendell
When Gary Mendell’s son committed suicide in 2011, amid a long struggle with the shame of addiction, the Connecticut hotel exec turned to activism. He launched a nonprofit, Shatterproof, which has pressed for state laws to increase naloxone access and provide immunity for drug users should they call 911 to report an overdose. Now comes his most ambitious effort. He’s assembled an army of health care influencers — including President Obama’s former drug czar — to evaluate dozens of addiction treatments. Armed with that information, Mendell intends to convince payers to cover evidence-based treatments for addiction just as they would cover established therapies for cancer or diabetes. “We know what should be done,” he said. “Now we have to get it done.”

THE SANCTUARIES: Drug injection sites
There are about 100 supervised-injection sites in the world. None are in the U.S. But cities like San Francisco and Seattle are trying to change that. It sounds audacious for public officials to give people a safe place to use illegal drugs. But advocates say stationing medical professionals at such sites can save people from fatal overdoses and eventually steer addicts toward treatment. Indeed, studies of such sites abroad show a reduction in overdose deaths.  “Some people think it’s enabling, but it’s going to help [drug users] and surrounding neighborhoods,” said Alex Kral, an epidemiologist with the nonprofit research institute RTI International. A task force in San Francisco is currently studying the issue. Officials in the Seattle area are looking for spots to build two facilities. “Regardless of the political discomfort I think it is something we have to move forward,” Dow Constantine, the executive of King County, which includes Seattle, told reporters.

THE ADMINISTRATOR: Tracy Plouck
As head of Ohio’s mental health and addiction services department, Tracy Plouck earns nearly much as Gov. John Kasich. It’s easy to see why. A member of Kasich’s cabinet since 2011, Plouck helped unite Ohio’s state agencies behind a nearly $1 billion plan featuring an aggressive series of initiatives to combat the opioid crisis, including youth prevention programs, treatment for the incarcerated, recovery support efforts, and increased naloxone access. In a state with one of the highest fatal overdose rates, Plouck has also pushed for more funding from D.C. while touting the benefits of Medicaid expansion, which she said has connected 500,000 low-income residents to addiction and mental health treatment. The state, though, doesn’t see its role ending at treatment: Ohio recently devoted $12 million to build housing for recovering addicts in underserved areas. “This helps people who’ve completed treatment not go back to the environment where your friends are still using,” Plouck said.

STAT forecast: Opioids could kill nearly 500,000 in U.S. in next decade

Photo Credits: Handout, AP, AP, Getty Images, Handout, Handout, AP, AP Stock, Handout, Handout, AP, and Handout.

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  • Let’s not forget the crime aspect to this by locking up the top dealers and finding a way to stop these drugs from getting into the US.

    • Yeah, because it’s time we really tried that approach!

      Come on. There will always be demand, so there will always be supply.

      Arrest one top dealer and another steps right in. Same with sources.

      We’ve at least learned that over the past 100 years, right?

  • Hi Jalair,
    The European Monitoring Centre for Drugs and Drug Addiction says, “the use of consumption facilities is associated with increased uptake both of detoxification and drug dependence treatment, including opioid substitution.” And that, “the Canadian cohort study documented that attendance at the Vancouver facility was associated with increased rates of referral to addiction care centres and increased rates of uptake of detoxification treatment and methadone maintenance.”

    Additionally, “Evaluation studies [across Europe] have found an overall positive impact on the communities where these facilities are located.”

    Yes, there is is “insufficient” evidence that shows consumption facilities reduce HIV and HCV infections, but this is something that is hard to determine based on the scope of these facilities and their methodologies. Nevertheless, the services they provide are proven to mitigate the risk of HIV and HCV transmission.

    • Hi, Jonathan. Please refer to the newer 2016 meta study and the resulting recommendation to utilize enhanced needle exchanges for proven, evidence based mitigation of risk of HIV and HCV transmission.

      My local elected officials and people across the country are hyping drug consumption sites as saving $6Mil per year in reducing HIV/HCV and they simply cannot make that claim. When they stop hyping the supposed savings, I’ll move on to other things. I’d like to focus on treatment and finding the best, evidence-based continuum of care.

  • I am one individual fighting drug consumption sites in Seattle/King County. If you are a physician or treatment provider, please critically read the studies that are presented as facts.

    King County is attempting to move forward with 2 pilot sites ($6 Mil) without treatment plans in plans. King County is woefully behind in comprehensive treatment and mental health assistance. If an person with SUD walks in to use a drug consumption booth, studies show the likelihood of entering into detox is less than 5%. (Source: InSite in Vancouver B.C. stats from 2015 entry into detox.)

    If you think Europe supports these sites, think again. The European Monitoring Center for Drugs and Drug Addiction, December 2016 Harm Reduction interventions for Opioid injectors Best Practices Portal: “There is: 1) insufficient evidence to support the effectiveness of drug consumption rooms in reducing HIV infections,2) insufficient evidence to support the effectiveness of drug consumption rooms in reducing HCV infections.” Europe is way ahead of the U.S. in evaluating these sites. The King County Opioid Task Force has repeatedl refused to dialog about this meta study and continue to claim massive public health savings based on avoided HIV/HCV transmissions. If you live in New York City, Baltimore, or San Francisco, you need to point out this issue and fast.

    Effective harm reduction strategies that reduce HIV/HCV transmission (as recommended by EMCDDA, the U.S. Surgeon General in November 2016 and CARA) can be successfully achieved with needle distribution sites enhanced with counseling, wound treatment, and other services.

    My opinion of the work we need to do is to provide detox and treatment when the person with a SUD is ready. If we don’t have this in place, things will be very grim in a few short years.

    Heroin and meth are illegal in this country and drug consumption sites are also illegal. Properties that are used for this activity can be seized by the federal government. At this time, with this particular Administration in power, proposing drug consumption sites is the height of hubris, in my opinion.

    Drug consumption sites extend the time it takes to enter detox and treatment–causing damage to brain and body.

    Speak Out Seattle! prefers long-term and evidence-based treatment.

    If you want a wicked cat fight with your constituents and potentially with the federal government, go ahead and label this an “innovative new approach.”

    Speak Out Seattle supports King County Initiative 27, which would make drug consumption sites illegal in King County.

    Don’t believe the hype. Not every “new” idea is a good one.

    • Your puritanical nonsense is part of the problem. I too live in king county, if you want fewer dead drug addicts and far less needles around you should support safe injections sites. I know it may be hard for you to believe but you have been brainwashed by the drug war, it’s not your fault

    • If you’re unsatisfied with the apparent efficacy of consumption sites, that’s fine… but other than “Trump!” you haven’t made a single argument that supports your position against them.

      (Unless you have supporting evidence, your opinion that “drug consumption sites extend the time it takes to enter detox and treatment–causing damage to brain and body” does not count.)

      Needle distribution sites and wound management and counselling are all fine things to have on offer, but not one of them will do a thing for overdoses. Meanwhile, InSite has “supervised” hundreds of thousands of doses and stopped thousands of overdoses… not one of which has resulted in a client’s death.

      D’you really think none of those people would have died otherwise? Or, as I strongly suspect from the quality of your post, are you just a NIMBYist once removed?

    • Hi, D. I’m not puritanical and this is not drug war hyperbole that I am talking about. Let’s look at the facts of drug consumption sites.

      Most overdoses would occur outside these sites. One site would monitor only 0.3% of total injections in King County. Naloxone distribution would save more lives.
      Fewer needles on the ground? Think again. When there are 69,000 injections per day and only 800 of them supervised. Most people with SUD will be using regardless, strewing needles wherever they are.
      Drug consumption sites divert limited resources away from detox and treatment. This includes the staff time we all pay for.
      Ineffective — Only 4% pass through detox at InSite in Vancouver, B.C. InSite will not share their treatment statistics after 15 years of existence. I think that absense of data speaks for itself.
      More effective harm reduction methods exist,
 such as enhanced needle distribution.

      I hope we can agree we need to encourage our local elected officials to create effective detox and treatment solutions to help people get their lives back.

      People who are opposed to drug consumption sites include treatment providers, former addicts who are helping others, and many many family members and friends. We believe in compassionate effective solutions to this problem.

  • What a load of sturm und drang… and all to avoid the simplest, most effective, and least expensive option of all: legalize and regulate the production and distribution of opiates/opioids for adults to buy in licensed dispensaries.
    If they need them for pain, fine.
    If they want to get high, fine.
    They’re adults, after all.
    Let’s remember that people are dying in record numbers because the drugs they’re using are either a) not theirs, i.e. unfamiliar or b) illegal, i.e. of variable strength and/or cut with fentanyl.
    Most overdoses would be avoided if people would die if they could just buy drugs of known purity and strength.
    Legalization would also cut organized drug crime off at the knees, and save bajillions in policing and first responder costs.
    That money could be put toward sane, safe, and perfectly legal treatment options for people who want out.
    But, of course, moral panic will keep us from doing the sane thing. So watch that death rate keep rising…

    • Totally NAILED it Ben. Since when have all these gigantic efforts to demonize drugs, their users, and doctors who prescribe them – done anything productive in our society. I lived in pain and depression for 30 years following a bilateral knee injury because my condition was labeled “chronic”. Sorry Jay – no pain relief for you for the next 30 years. Sorry about the kidney issues you developed by using ibuprofen for pain relief all that time – we think its more important that you experience kidney disease than expose you to the terrors of opiate use. It’s time to put on all our big boy and big girl pants and be adults. I had to undergo multiple surgeries for my knees while going to college and was prescribed opiates for post-surgical pain. Guess what? I still graduated Suma Cum Laude with a 4.0 GPA and NO FREAKING ADDICTION!!! Grow up people!

  • I am, along with the 100 millions of other Americans, are on the other end of opioids. I am one of these 100 million Americans who have chronic incurable pain Diseases. As the CDC, DEA, FDA, Medicaid and Medicare, and numerous other government agencies, are blaming Doctors for the over prescribing of opioid medication. NOBODY, is looking at or reading the statistics from chronic pain disease patients. How about NOT addressing these drugs as dangerous and addictive. When all else fails, which all of us chronic pain disease patients are required to do. Lets address this medication as lifesaving and medically necessary for the million of Americans with chronic diseases. Chronic pain is a disease. Chronic pain disease patients are now the epidemic. The addiction rate of chronic pain disease patients is .02-.6 %. We do not misuse or abuse our medications.
    No other disease medication is scrutinized. We, as patients, are being denied, dismissed, overlooked and discriminated against, by our physicians, due to all the scrutiny associated with treating chronic pain disease with opioid medications. Our Dr’s are afraid to treat us humanely and adequately. We have a disease that medication is readily accessible to us and we are being denied. We, pain patients, are being discriminated against, due to people who abuse illegal heroin, illegal fentanyl and place the blame on everyone but themselves. This is a direct hunt for Doctors who prescribe life saving medication, for pain disease patients, that benefit from these medications.
    We have a chronic disease. We want to be able to take care of our homes, our children, our selves, as much as possible, but without access to these life saving medications, we are unable to do so. We want to live not just exist in pain 24/7.
    We need the government agencies to look at the real statistics, not the hand picked. These agencies are not physicians. They are trying to doctor us, patients, without a medical license. They are also trying to police our physicians. This is a war on a disease and medications to treat us.
    We need help. All the headlines, topics and stories on how opioids are bad and how people are abusing and dying from them. We need to look at the good they do and how they help our disease of chronic pain and the million of Americans who use/need them for some relief.
    The government needs to put the focus on illegal drugs coming into, being manufactured and distributed in this country, illegal fentanyl, illegal heroin, methamphetamine, cocaine and all other ILLEGAL DRUGS. People who abuse and misuse medication or illegal drugs will always find a way to get them illegally. Put the focus on that. Not the legally and medically necessary medications we patients need.

    • I agree! My husband is a disabled veteran with chronic, debilitating pain. Recently, because the government decided to lump ALL opioid users together, the VA had decided to cut his meds down to almost nothing, explaining that “there are people dying from opioid use every day”! Now he is living in constant pain and his quality of life has definitely diminished. So, instead of treating people as individuals and with compassion the VA has decided to make my husband’s life a living hell.

  • Good focus on positive ideas, but I’m still looking for more substantive thoughts about prevention. It’s one thing to address treatment but quite another to ask why so many people in our society are attracted to the over-use of mind-altering substances. Yes, doctors need to be careful in prescribing pain meds, but the opioid “epidemic” goes way beyond that. We need to ask how communities can go about reducing the demand for opioids. I do think we need at least to consider the social conditions that give rise to the “epidemic” of desire to change physical and emotional sensations.
    That’s my two cents as a medical sociologist who has been following a cohort drug users for about a decade.

  • Good list of good people doing good things. If I may add: M. speciosa (kratom) and the efforts by many, including American Kratom Association’s efforts to keep it legal, has made quite an impact on people already suffering with Substance Use Disorder as well as prevention by being able to decrease the opioids consumed by people who suffer from various ailments. A very valuable tool, for many people and for many reasons.

  • I was shocked by the statement “Drug users cut, crush, and grind prescription pills hoping to get high.” Actually, we take the medications as prescribed — the right amount, at the right time, in the right form.
    The problem is that when “top-down” programs are planned and implemented, lots of things can (and do) go wrong.
    I take a strong opioid to help me manage chronic pain — the right amount, at the right time, in the right form. I have used other things, like over-the-counter meds which are no longer effective, and which have ruined my liver. I would be a mess without that opioid medication. I might even have to turn to “street drugs,” a very unhealthy process. So when people are doing all the planning and implementing, I hope they do not mistreat people like me who have a legitimate need for opioids, whether short-term or long-term.

    • I don’t know your medical history but I felt that way not long ago too. But 6 months on ~low dose~ prednisone dramatically lessened pain and other symptoms and dramatically improved my quality of life. No Dr wanted to approve my trying that, said it was too risky. One finally did. At low does or less than 10 mg/day, you get the benefits but not the nasty side effects.

      A second option is cannibidiol (sp) oil, which is processed differently and is therefore NOT addictive. If the USA moved to this, many patients could get off of addicting opiates…and the drug cartels would be forced out of business and the treatment centers would lose customers (or be left to focus on other types of addictions). There is no reason to continue on the same old, same old path that has proven to be ineffective, horrific and expensive:(

  • What about suboxone and subutex? Why these meds are so expensive? Why some states will not pay for subutex unless you are a pregnant woman? Why pushing vivitrol without providing any support to help these patients through withdrawal? I want to be involved however I have not yet been able to via Public health which will have a larger impact connect or know how to start in the D.C. Area!

  • While very well intentioned, all these so called experts have ignored the most important factor; what has made these addicts so miserable that they would do drugs in such an unsafe manor. The only one that is counter productive is the educator, scaring doctors into being opiophobic is terrible

    • Well, it is 12 different people/organizations taking on 12 different aspects of the problem. And of course an individual’s background is an important factor in deterring someone from continuing to use, but not every person is suited to give intense psychological counseling or behavioral therapy.

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