Elements of a Comprehensive Public Health Response to the Opioid Crisis
Authors: Mark Levine, Michael Fraser
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions20 November 2018Elements of a Comprehensive Public Health Response to the Opioid CrisisMark Levine, MD and Michael Fraser, PhD, MSMark Levine, MDVermont Department of Health, Burlington, Vermont (M.L.)Search for more papers by this author and Michael Fraser, PhD, MSAssociation of State and Territorial Health Officials, Arlington, Virginia (M.F.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1757 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The U.S. Centers for Disease Control and Prevention's report of 116 overdose deaths a day from prescription and illicit opioids in 2016 underscores the need for urgent action to prevent overdose deaths, promote evidence-based programs for treatment and recovery, and implement programs and policies that support the primary prevention of addiction (1, 2). Significant attention has been paid to the government response to the opioid epidemic and the efforts needed to guide federal and state agencies and assets to address the crisis. The public health response to date at federal and state levels has consistently focused on several major tactics: ...References1. Seth P, Scholl L, Rudd RA, Bacon S. Overdose deaths involving opioids, cocaine, and psychostimulants—United States, 2015-2016. MMWR Morb Mortal Wkly Rep. 2018;67:349-58. [PMID: 29596405] doi:10.15585/mmwr.mm6712a1 CrossrefMedlineGoogle Scholar2. U.S. Department of Health and Human Services. What is the U.S. opioid epidemic? 2018. Accessed at www.hhs.gov/opioids/about-the-epidemic/index.html on 18 June 2018. Google Scholar3. Butler JC. 2017 ASTHO President's Challenge: public health approaches to preventing substance misuse and addiction. J Public Health Manag Pract. 2017;23:531-6. [PMID: 28759556] doi:10.1097/PHH.0000000000000631 CrossrefMedlineGoogle Scholar4. Trust for America's Health. Pain in the nation. 21 November 2017. Accessed at www.healthyamericans.org/reports/paininthenation on 18 June 2018. Google Scholar5. Wickramatilake S, Zur J, Mulvaney-Day N, Klimo MC, Selmi E, Harwood H. How states are tackling the opioid crisis. Public Health Rep. 2017;132:171-9. [PMID: 28152337] doi:10.1177/0033354916688206 CrossrefMedlineGoogle Scholar6. Association of State and Territorial Health Offices. Preventing opioid misuse in the states and territories: a public health framework for cross-sector leadership. 2018. Accessed at https://my.astho.org/opioids/home on 18 June 2018. Google Scholar7. National Safety Council. Prescription nation 2018. 2018. Accessed at www.nsc.org/home-safety/safety-topics/opioids/prescription-nation on 18 June 2018. Google Scholar8. Murphy K, Becker M, Locke J, Kelleher C, McLeod J, Isasi F. Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States. Washington, DC: National Governors Association Center for Best Practices; July 2016. Google Scholar9. Johns Hopkins Bloomberg School of Public Health. The Opioid Epidemic: From Evidence to Impact. Baltimore: Johns Hopkins Bloomberg School of Public Health; October 2017. Google Scholar10. Pitt AL, Humphreys K, Brandeau ML. Modeling health benefits and harms of public policy responses to the US opioid epidemic. Am J Public Health. 2018;108:1394-400. [PMID: 30138057] doi:10.2105/AJPH.2018.304590 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Vermont Department of Health, Burlington, Vermont (M.L.)Association of State and Territorial Health Officials, Arlington, Virginia (M.F.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1757.Corresponding Author: Mark Levine, MD, Commissioner of Health, Vermont Department of Health, 108 Cherry Street, PO Box 70, Burlington, VT 05402-0070; e-mail, Mark.[email protected]gov.Current Author Addresses: Dr. Levine: Commissioner of Health, Vermont Department of Health, 108 Cherry Street, PO Box 70, Burlington, VT 05402-0070.Dr. Fraser: Executive Director, Association of State and Territorial Health Officials (ASTHO), 2231 Crystal Drive, Suite 450, Arlington, VA 22202.Author Contributions: Conception and design: M. Levine, M. Fraser.Analysis and interpretation of the data: M. Levine, M. Fraser.Drafting of the article: M. Levine, M. Fraser.Critical revision of the article for important intellectual content: M. Levine, M. Fraser.Final approval of the article: M. Levine, M. Fraser.Administrative, technical, or logistic support: M. Fraser.Collection and assembly of data: M. Levine, M. Fraser.This article was published at Annals.org on 6 November 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMountain or molehill? A scoping review of evidence on an opioid use problem in IsraelAssociation Between Interorganizational Collaboration in Opioid Response and Treatment Capacity for Opioid Use Disorder in Counties of Five States: A Cross-Sectional StudyMulti-informant Implementation and Intervention Outcomes of Opioid Overdose Education and Naloxone Distribution in New York CityTwo‐year outcomes following naloxone administration by police officers or emergency medical services personnelThe cascade of care for opioid use disorder: a retrospective study in British Columbia, CanadaA comparison of opioids and benzodiazepines dispensing in Australia 20 November 2018Volume 169, Issue 10Page: 712-715KeywordsHealth careHealth education and awarenessOpioid addictionOpioid use disorderOpioidsPregnancyPrevention, policy, and public healthPublic policyTherapeutic drug monitoringVision ePublished: 6 November 2018 Issue Published: 20 November 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. 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