The Opioid Data Crisis
by Jason S. Brinkley, PhD, MA, MS
On the Brink addresses topics related to data, analytics, and visualizations on personal health and public health research. This column explores current practices in the health arena and how both the data and mathematical sciences have an impact. (The opinions and views represented here are the author’s own and do not reflect any group for which the author has an association.)
Opioid addiction is having a tremendous impact on the United States. The CDC says that all-cause overdose deaths have more than tripled from approximately 20,000 in 2000 to over 64,000 overdose deaths in 2016, with 70% of 2016 deaths linked to opioids. Agencies at all levels of government struggle to help combat the epidemic, with an extra 3 billion dollars in federal funds from the recent omnibus bill to help attack the problem across multiple sources. This cash infusion has come with a new set of problems. As groups discern the best way to attack the crisis a new problem has emerged: the lack of timely, complete, and useful data for decision making. In order to deal with the opioid crisis, the United States is going to first have to tackle its opioid data crisis.
Let’s start with the foundation problem – the fact that the crisis is actually the convergence of abuses from three groups of substances: prescription drug abuse (like OxyContin® or Vicodin®), use of illicit Heroin, and the recent rise of synthetics such as Fentanyl. A great background and summary of all of this can be found on the National Institute on Drug Abuse’s website; or if you are into podcasts, here is some great info from Science Vs. But the three-fold problem leads to a whole slew of data-related challenges. First, attributing how much each substance contributes to the overall crisis is tough as the data collected in each area is totally different. Overall, we can assess the impact prescription drugs has through health-related resources, which is in contrast with tracking of illegal street drugs which is usually done through criminal justice sources. We only tend to get combined information on sources for individuals who have overdosed or among those that have entered into certain treatment or social programs. Second, privacy concerns and regulations make linking these disparate data a real challenge. While keeping sensitive information private is a major concern, currently many groups are working in silos because of the lack of data sharing opportunities. Third, assessing the impact of interventions can be tough because of the many different ways opioids can lead to poor outcomes. For example, criminalizing opioid use can lead to decreased overdoses but lead to overcrowding in jails and prisons. Or concerns abound on the widespread use of medication-assisted treatment such as Buprenorphine because of fears of continued long term use.
In the face of all these data challenges, there have been some big wins. Different groups are working with the data that is currently available to help show how opioids are impacting different parts of the country. One prime example is the recent work by BNL Consulting, which has put together a fantastic set of easy-to-explore dashboards to learn more about the opioid epidemic. I saw their dashboards and gave them the highest praise I could think of: “I wish I had done that.” I’ve included a screengrab of one of their visuals below, but you should interact with the full website in order to get the full experience. The limitations of the website are inherent given the challenges I’ve described above. They rely heavily on Medicare data, highlight the problem too far downstream to fix, and have access to only data through 2015, which is not as useful for policy makers looking to explore different initiatives. It’s great at describing the problem, but that doesn’t necessarily get us closer to solutions.
Beyond helping to tell the story of the opioid crisis, data scientists and technologists are helping with new innovations that show great promise. Application makers are developing apps to help individuals find rehab or treatment facilities, get information, or even find someone to do drugs with (to reduce OD risk by not using alone). One resource I want to highlight is the website for StreetRX, which has crowd-sourced information on the local street price of many illicit drugs, opioids included. The website shows that users recently report (ie, May 2018) buying opioids for as low as $5 per pill in some of the highest impacted areas. Getting this kind of real-time information is going to be critical in any long term opioid strategy. One thing is clear: many independent groups are working on the problem, but it is unlikely that we will fully be able to deal with the actual crisis until we deal with the data crisis.
For further reading, consider these related articles from the Journal of Public Health Management & Practice*:
- Deaths of Despair and Building a National Resilience Strategy
- The North American Opioid Experience and the Role of Community Pharmacy
- Promoting Health Department Opioid-Prescribing Guidelines for New York City Emergency Departments: A Qualitative Evaluation
- A Survey of Prescribers’ Attitudes, Knowledge, Comfort, and Fear of Consequences Related to an Opioid Overdose Education and Naloxone Distribution Program
*Articles may require a subscription to JPHMP or purchase.
Jason S. Brinkley, PhD, MS, MA is a Senior Researcher and Biostatistician at Abt Associates Inc. where he works on a wide variety of data for health services, policy, and disparities research. He maintains a research affiliation with the North Carolina Agromedicine Institute and serves on the executive committee for the NC Chapter of the American Statistical Association and the Southeast SAS Users Group. Follow him on Twitter. [Full Bio]
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- Does MACRA Signal the Beginning of the End for Medicare Claims Data?
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