As the Covid-19 epidemic sweeps across the country leaving death and confusion in its wake, let’s not forget the other epidemic — opioid overdose deaths — that continues to do the same thing and that was until just a few months ago considered to be the greatest public health crisis of this generation.
I’m fascinated, and appalled, by one huge difference between them: data.
The curious, the worried, the obsessed, and the scientific community can follow the effects of Covid-19 in real time. There are a number of online dashboards tracking the outbreak worldwide as well as here in the United States.
Within a few weeks from the time the first cases were diagnosed in Wuhan, China, anyone with an internet connection could monitor the spread and effects of Covid-19. More importantly, elected leaders, scientists, and health care workers can see these data and use them to inform their responses and their choices of interventions in real time. This is enormously helpful. Indeed, an intervention without such real-time outcome data is like working in the dark.
There’s no question that Covid-19 is a deadly plague, with more than 90,000 deaths in the U.S. since January 2020. Opioids are equally deadly, with approximately 450,000 lives lost to taking opioids between 1999 and 2017. In 2018 alone, there were 67,367 deaths involving opioids, and this breathtaking number actually reflected a slight improvement, as it was about 4% fewer than those lost in the year prior.
I’m quoting old numbers from 2018 and 2017 because data from 2019 isn’t available. According to the National Institute on Drug Addiction, 2019 data will be “released in early 2021, at which time, these pages will be updated.”
In other words, the closest thing we have to a real-time data system for opioid overdose deaths — an epidemic of destruction that began killing Americans more than a decade ago — has a lag time of about 24 months.
The consequences of not having real-time data for any public health crisis is lethal.
In Missouri, where I live and work, the state Department of Mental Health along with the Missouri Institute of Mental Health began receiving funds in early 2017 and has since been awarded about $66 million to fight the opioid epidemic.
That’s a lot of money, but the need was great. Although some claim that addiction is an equal opportunity destroyer, it isn’t. Missouri’s opioid epidemic was harming African Americans at a much higher rate than white people, and the city of St Louis has continuously led the state in drug overdose rates. Those trends, which still persist, perversely mirror the disproportionate effects of Covid-19 on people of color.
After putting its medication-first plan into place in 2017, we had to wait about two years to see how well it was working. For a deadly disease like addiction, that wait time is unacceptable — and horrifying.
When the results of the plan to reduce opioid overdose deaths finally arrived in 2019, they weren’t good. While the nation and most states had experienced an overall decrease in opioid-related deaths, Missouri remained an outlier. It was one of just a few states where death rates have steadily increased year-over-year since it implemented the response in 2017. Unfortunately, the latest updated data continue to show Missouri’s opioid-related deaths rising while most other states’ are falling. Yet state leaders plan to stay the course as they believe that the lack of progress does not lie with their original plan but results from social, economic, and judicial issues in the state. With real-time, real-world data, they should be able to prove that contention — or take a different tack.
The long lag time for outcome data, which is not unique to Missouri, is completely unjustified. Missouri funds many substance use disorder treatment programs. In return for those funds, programs must send patient services and other claims information to the state’s CIMOR system. In addition, the millions of federal dollars allocated to the state come with a requirement to collect outcome data on a regular basis. Add in hospital and overdose reversal data, which the state collects, and it should have ample information to share with both taxpaying citizens and professionals working to stop overdose deaths from occurring.
Most, if not all, of these data are generated by tax dollars. They do not belong to the state or any organization, they belong to all of us. Instead of publishing their belated findings in academic journals, which do little more than advance individual careers, researchers in Missouri and every other state should create a system that makes outcome data available to everyone in something much closer to real time.
The public has benefited from seeing the spread of the Covid-19 pandemic in the moment. Although it is scary seeing the numbers of diagnoses and deaths rising day by day, these data help bring clarity and accountability to an ongoing crisis that requires both.
It is time to bring this kind of real-time outcome data to America’s addiction crisis and make it available to the public. It’s the only way of knowing if what we’re doing to address the problem is making a difference. Without it, we’re relying on little more than prolonged intuition. Without it, we’re just guessing.
David A. Patterson Silver Wolf is an associate professor in the George Warren Brown School of Social Work at Washington University in St. Louis, where he is a faculty scholar with Washington University’s Institute for Public Health and also serves as a faculty member for two training programs funded by the National Institute on Drug Abuse.