By: Colleen Carey
ASHEcon and the Association of Public Policy Analysis and Management (APPAM) joined forces on January 18, 2018 for a webinar on one of the most pressing health policy challenges of our time – the new epidemic of opioid addiction. The webinar, entitled “Intersection of Opioid Addiction and Evidence-Based Policy” was an example of the benefits of the new partnership between the two sponsoring organizations. Four ASHEcon and APPAM members shared their expertise with 206 real-time participants (and another 192 who listened to the recording) on how research on the opioid crisis has helped inform the policy response to the crisis, as well as where more work or a new approach is needed.
Kosali Simon, a professor at Indiana University, led off the webinar with a discussion on how economic tools can be leveraged for insight into the epidemic. Simon framed the epidemic by comparing the explosive growth in drug-related deaths in the US since 2000 with the modest growth experienced even in other nations with high opioid utilization rates. While the epidemic is new, economists can draw on a long literature in informational asymmetries (e.g., between patients and providers in the risks of treatment, or between providers and “doctor-shopping” patients), models of addiction, and the economics of illicit markets. In conclusion, Simon emphasized the epidemic’s shift from prescription opioids (which have begun to fall) to illicit opioids such as heroin and fentanyl, which poses a challenge for researchers because of the relative lack of datasets measuring illicit drug use.
The next researcher gave an overview of governmental responses. Jevay Grooms is currently a Postdoctoral Fellow at University of Washington; in the fall she will join the Department of Economics at Howard University as an Assistant Professor. Grooms covered the efforts at the Federal level to promote lower-risk prescribing guidelines, as well as the key contribution of Federal funds to state and local governments. States have a direct role in licensing health care professions, and several states have enacted new legislation regulating pain clinics to combat “pill mills”. Nearly every state has sought to better inform providers about their patients’ behavior via a Prescription Drug Monitoring Program that collates an individual’s prescriptions across prescribers and settings of care.
Carroline Lobo, the third contributor, is a doctoral candidate at the University of Pittsburgh. Lobo analyzed how the health system has mobilized to combat the epidemic, describing four major areas of intervention. Firstly, the health system engaged in a multi-level campaign of patient and provider education about the risks of opioids. Secondly, the health system has been instrumental in promoting naloxone access as a harm-reduction strategy for the currently addicted. A third area of intervention, often led by insurers, focuses on monitoring of patient claims to identify cases of risky utilization and to work with providers to intervene with these individuals. Finally, a set of interventions aim to change the prescribing of opioids, including both clinical guidelines and professional guidance on the use of Prescription Drug Monitoring Programs.
The final contributor, Colleen Carey, is an Assistant Professor at Cornell University. Carey covered the particular strengths of economists, in collaboration with our clinician and health services colleagues, in deepening our understanding of the epidemic. Economists are well-trained in establishing causation in complex situations (e.g., investigating the multifaceted role of health insurance expansions), as well as disentangling supply and demand. She called for policymakers to recognize that economics articles are written for other economists, and thus the policy implications are not always made explicit. In turn, however, economists can pursue companion pieces to formal articles that clarify how the research applies to current debates.
ASHEcon and APPAM look forward to planning other collaborations.
Colleen Carey is an Assistant Professor of Policy Analysis and Management at Cornell University. She has a Ph.D. from Johns Hopkins University.