This week, MHA released a fact sheet on the opioid epidemic contrasting drug- and opioid-related deaths to fatalities caused by motor vehicles. The comparative is instructive in several ways. First, there is a clear point in the 1960s when vehicle accident-related deaths reached a tipping point, spurring government action to increase safety. Second, efforts to address the public health and safety aspects of the challenge included citizens, government and industry — there was no single “silver-bullet” policy.
Identifying tipping points is easier in hindsight. However, a powerful argument for a tipping point moment occurred in 2010 in Missouri, when drug-related deaths exceeded vehicle accident fatalities. Another potent message related to the crisis was delivered in 2015 and 2016 when life expectancy dipped for the first time in decades as the opioid crisis chipped away at the progress made in improving public and individual health.
Click on the map above to view an animated time-lapse from 2001 through 2016.
Despite multifaceted efforts, including outreach by the Department of Health and Senior Services, collaboration among the provider community to set standards for opioid prescribing in emergency departments and other efforts, opioid- and drug-related deaths continue to skyrocket in Missouri. We have yet to see full coordination with a strategic plan to address the problem and appropriate funding to finance the costs.
In the 1960s, two pieces of legislation — one focused primarily on how government policies and investments could reduce vehicle fatalities and one focused largely on citizens and industry — began the half-century decline in motor vehicle-related deaths. It was not a single intervention, like mandatory seat belts, that bent the accident fatality curve downward. It was a multifaceted approach, including better roads and additional roadway safety investments, vehicle and driver licensing, and safer products from automakers.
The effort to curb the toll of drug and opioid deaths will require a similar effort. A prescription drug monitoring program isn’t the only answer, just as seat belts weren’t the only answer to roadway safety. Nonetheless, a PDMP could act as a traffic signal at the point of care. As the patient and health care provider approach the care intersection, a PDMP could offer an important signal to the provider and increase safety for the patient.
The scope of the opioid crisis will require a broad set of policies and new ideas about interventions. And, Missouri has taken several steps in the right direction, including reducing the legal dangers of reporting and assisting with overdose victims and opening access to naloxone to reverse opioid overdose. However, there are a myriad of other policies that will be necessary, including more education, behavioral health and substance use disorder interventions, and coordination with law enforcement, among others.
The Trump administration has declared the opioid crisis a national public health emergency. However, the policies necessary to address the problem and crisis-level funding have not emerged.
Despite the grassroots establishment of a robust county-based PDMP — covering 80 percent of Missourians and 90 percent of health care providers — Missouri is the only state in the nation yet to adopt a statewide PDMP. However, the efforts to date have not been sufficient to reverse the back-to-back years with double-digit increases in opioid overdose deaths. Missouri has significantly higher opioid-related mortality rates than the rest of the country. The number of deaths from fentanyl more than doubled between 2015 and 2016. Unfortunately, the state already had one of the lowest life expectancies in the country. It is unlikely that Missouri will be able to fully address the problem without additional federal help.
More than a half-century after the federal highway safety initiatives, the laws continue to provide a framework for addressing a public health and safety challenge of this magnitude. All evidence suggests that the tipping point for the opioid crisis has passed. Unfortunately, the death toll continues to grow.
As a state and nation, we can — and we must — do more.
I’m always interested in your thoughts.
Herb B. Kuhn
MHA President and CEO
In This Issue
MedPAC Recommends Full Marketbasket Update For FY 2019
CMS Announces IPFQR Webinar
January 8, 2018
Updated List Of ACOs Available
CMS Publishes CLIA RFI
MHA Releases New Data On The Opioid Crisis In Missouri
CMS Announces Hospital Quality Reporting January 2018 System Release
January 9, 2018
Task Force Recommends Rural Objectives To President
Research Indicates Higher Probability Of Hospital Closures In Nonexpansion States
January 10, 2018
FFY 2018 Medicare Pay-For-Performance Measure Trends Available
CMS Announces New Voluntary Bundled Payment Models
House Republicans Seek 340B Reforms
CMS Updates Schematron For CY 2018 QRDA I Implementation Guide
Plaintiffs To Appeal Dismissal Of 340B Challenge
January 11, 2018
Greitens Delivers State Of The State Speech
Legislative Committee Reviews FRA Reauthorization Legislation
CBO Estimates Cost To Extend CHIP
CMS Provides Guidance For States To Test Community Engagement For Able-Bodied Adults
WPS Adds Emergency Evaluation And Management Coding To The Probe And Educate Review Process
DHSS Requests Pre-Designated Alternative Administrator
MLN Connects Provider eNews Available
Missouri Foundation For Health Releases New Report On Mortality In Missouri
Influenza Activity in Missouri Continues, MHA Activates Queries To Monitor Impact
Opioid STR Announces MAT Waiver Training