July 2018: Diseases of Despair
by Lloyd F. Novick, MD, MPH
The editorial and first three articles of the July/August issue of the Journal of Public Health Management and Practice focus on adverse health outcomes attributable to substance abuse. The lead editorial “Deaths of Despair and Building a National Resilience Strategy” by John Auerbach, President and CEO, Trust for America’s Health, and Benjamin Miller, Chief Strategy Officer, Well Being Trust, presents shocking information on a triple set of epidemics—more than 1 million Americans have died from drug overdoses, alcohol abuse, and suicide between 2006 and 2015. In 2016, 142,000 individuals, the highest number ever recorded, died from alcohol, drug-induced fatalities, and suicide. Life expectancy in the United States has now decreased for two years in a row. As the authors point out, all groups in this country are vulnerable to these deaths. Drug overdoses are highest among Whites. However, in 2016, there were disproportionately large increases in drug deaths among racial/ethnic minorities, particularly among Black Americans.
The current opioid crisis is now the deadliest drug epidemic in American history. The mortality from this cause rivals the number of American deaths per year at the peak of the AIDS crisis. After initial delay, Congress did act by providing funding for AIDS prevention, treatment, and research. A similar effort is needed now to address the opioid problem.
Jerome Adams MD, MPH, the US Surgeon General, has urged health care practitioners, family, and friends of people with opioid addiction, and community members who come into contact with people at risk of opioid overdose to know how to use and access naloxone. Two articles in this journal issue address this recommendation.
The veteran population is at an even higher risk for fatal opioid overdose poisoning in comparison to the non-veteran population. Heroin, methadone, and other opioids were identified as causal agents in the deaths of 39% of veteran accidental poisonings. In May 2014, the US Under Secretary of Health mandated the implementation of Opioid Overdose Education and Naloxone Distribution (OEND) programs across all Veterans Affairs (VA) facilities to combat the opioid epidemic. In a survey of VA healthcare system providers, Alyssa Peckham, PharmD, and colleagues found that certain groups of medical practitioners are not as receptive to distribution of naloxone but that education can have a significant positive impact on attitudes.
In a commentary “The North American Opioid Experience and the Role of Community Pharmacy,” Zahara Rosenberg-Yunger and colleagues describe their experience in Canada where community pharmacists are expected to ensure that prescribers are following guidelines for opioids prescribing including suggesting non-opioid alternatives.
Today’s opioid crisis can be traced to the 1990s when practitioners began to commonly prescribe painkillers like OxyContin and Vicodin. Frederick Nagel, MD, of the North Central Bronx Hospital Emergency Department, Albert Einstein College of Medicine, and colleagues report on an effort to address the epidemic of opioid misuse and overdose by a partnership of emergency medicine physicians and the New York City Department of Health and Mental Hygiene (DOHMH) to develop voluntary guidelines for judicious prescribing of opioids upon discharge from an emergency department. Promulgation of judicious opioid prescribing guidelines is central to the New York City (DOHMH) multi-pronged strategy to reduce opioid analgesic overdose deaths.
This issue contains an interesting “Management Moment” column edited by Edward Baker, MD, MPH, titled “Preventing Leader Derailment-A Strategic Imperative for Public Health Agencies.” This insightful look at the challenges facing those who serve as State Health Officials (SHOs) provides excellent guidance not only for senior public health leaders but for all working in public health and other fields. The “Management Moment” column is an integral and valued element of JPHMP exemplifying the mission of our publication. In future issues, we will be featuring more articles on SHOs emanating from a de Beaumont funded project led by Dean Paul Halverson at the Fairbanks School of Public Health, Indianapolis, Indiana.
Lloyd F. Novick, MD, MPH is the Founding Editor and Editor-in-Chief of the Journal of Public Health Management and Practice and Professor Emeritus of the Department of Public Health at the Brody School of Medicine, East Carolina University. Follow him on Twitter. [Full Bio]