October 3, 2018

4 Ways to Reduce Opioid Misuse and Overdose

Promising strategies for those working to prevent misuse in their communities.

"“We have a better chance at making change when we use tactics that have been proven to work,” says Gisela Rots.

With an estimated 115 Americans dying each day from opioid overdoses, tackling the country’s opioid crisis is a top priority for public health professionals. But how should they do it?

“If we want to reduce opioid misuse, then we have to take a prevention approach,” says EDC’s Gisela Rots. “Rates of youth smoking and drinking have gone way down over the past 20 years because we figured out that prevention works.”

Prevention programs can take many forms—from large statewide campaigns to initiatives targeted at specific at-risk individuals. Here, Rots and Shai Fuxman, both of whom are with Prevention Solutions@EDC, offer four ideas for health professionals, educators, and others who want to prevent opioid misuse in their communities.

1. Create public messaging campaigns

Public messaging campaigns can raise awareness about a specific health issue or even create the conditions necessary for behavioral change.

But not all messages are created equal. Research has shown that campaigns that paint drug misuse as simply the wrong thing to do—such as the “Just Say No” campaign of the 1980s—do not work.

“We’ve learned that effective public messaging tries to educate and inform people—it doesn’t rely heavily on scare tactics,” says Rots.

In fact, research has shown that effective public health campaigns do three things:

  • They are part of a more comprehensive campaign.
  • They present a clear message and action steps.
  • They deliver the right message to the right audience through the right channels.

As an example, Rots points to Virginia’s “Curb the Crisis” campaign, which EDC and the public relations firm Reingold are working on. The campaign tells authentic stories about how opioid misuse can lead to overdose and gives real information about the scope of the problem.

While “Curb the Crisis” is still in the early stages of being rolled out, Rots is hoping that it will reduce the stigma around opioid misuse and help link Virginians to resources, including naloxone and information about treatment.

“We have a better chance at making change when we use tactics that have been proven to work,” she says.

2. Work with prescribers

Since prescription opioids can be highly addictive, working directly with opioid prescribers on misuse prevention is also imperative.

Fuxman points to Utah as a prime example of how prescriber education programs can be successful. Since 2008, the Utah Department of Health has coordinated programs that educate physicians on how to prescribe opioids safely. As a result of this work, 60 to 80 percent of participating physicians stopped prescribing long-acting opioids for acute pain, and 50 percent reported using lower starting doses and slower escalations to reduce the risk of addiction.

“The goal of prescriber education programs is to make sure that prescribers are using safe practices to help their patients manage their physical pain without becoming addicted to opioids,” says Fuxman.

Fuxman points to Arizona as another promising example. There, the state’s Board of Pharmacies issues prescriber “report cards,” which allow physicians to see if they are prescribing more or fewer opioids than other doctors.

“Seeing how they compare to their peers can motivate doctors to adopt responsible prescribing practices,” he says.

3. Create post-overdose programs

Despite public messaging campaigns and prescriber education efforts, opioid overdoses will still occur—and people who survive an overdose are at increased risk of dying from another one. This is why programs to support individuals who have survived an opioid overdose are also an important part of prevention.

These programs are based on some key principles, including establishing positive relationships with survivors and helping survivors navigate social services systems. As Fuxman says, post-overdose programs are “proactive efforts to prevent a future overdose.”

In fact, some early evaluation studies of post-overdose programs seem promising. In California, one pilot program had clinicians call overdose survivors within 24 hours of an overdose, resulting in 33 percent of survivors visiting a treatment provider after receiving the call. And in Massachusetts, a voluntary police-led referral program placed 75 percent of overdose survivors into treatment.

For overdose survivors, referral to treatment is an important first step in getting help—and it also marks an important shift in how law enforcement handles addiction, says Fuxman.

“In positioning opioid abuse as a health issue, not a law enforcement issue, we are finally beginning to recognize that addiction needs to be treated like the disease that it is,” he says.

4. Start prevention early

Finally, while the opioid crisis is grabbing headlines now, the larger issue of substance misuse is not new—and it’s not going away anytime soon, says Rots. So in addition to programs that seek to prevent the immediate misuse of opioids, she says that parents and educators can also help prevent substance misuse down the road.

“When we talk with young people about the importance of mental health, when we value the positive contributions that young people make, when we help them develop strong and lasting relationships with adults and peers—we are engaging in prevention strategies, too,” she says.

In fact, research has shown that efforts to reduce the impact of childhood trauma, create strong family bonds, and build a sense of belonging within a community are all effective in reducing alcohol and drug abuse among youth. Rots says that these programs help prepare young people to cope with some of the struggles and disappointments that they may experience later in life—experiences that sometimes plant the seeds of drug abuse.

“We all have a role to play in keeping young people healthy and resilient,” says Rots. “Ultimately, that’s the best prevention there is.”