Are We Making Progress Against the Opioid Epidemic?

Ashish Jha: 00:00:06

Hey, folks, Ashish Jha here from Providence, Rhode Island. Welcome back to A Moment in Health. This is the podcast where we talk about one data point and we talk about one study, and then we answer one question, and sometimes that question and sometimes that question will be answered by me

Ashish Jha: 00:00:22

and sometimes by somebody else. And we have a guest back today, new guest to answer a question. But let's get started with a data point. And the data point I want to talk about today, the number you should have in your head is one in three. One in three Americans who have employer sponsored health

Ashish Jha: 00:00:39

insurance. These are people who get health insurance through their employer, like I do, one in three have benefited from the preventive services feature of the Affordable Care Act. This all sounds very technical. Let me take a moment to talk about why this is really important, because there is a new legal

Ashish Jha: 00:00:54

case going to the Supreme Court on this, and it's going to make a big difference if you care about prevention. So the Affordable Care Act, ACA, also known lovingly as Obamacare, had a provision it really wanted to push prevention, and so it had a provision which said preventive services must be covered for

Ashish Jha: 00:01:12

free by private health insurance companies. Now, of course, the question is, what counts as preventive services? So the Affordable Care Act said that the US Preventive Services Task Force would make that determination. There are a group of scientists that are convened by the Department of Health and

Ashish Jha: 00:01:29

Human Services, and they would make a recommendation to the health secretary, who would then implement that Okay, so that's the procedure part of this. But what kind of health services are we talking about? We're talking about immunization, vaccines against flu, for instance, we're talking about mammograms, we're

Ashish Jha: 00:01:44

talking about colon cancer screening, things that we think actually have pretty good evidence behind them and make a big difference. There is a lawsuit that says, Is this legal? Can you really force private insurance companies to cover this? And the number for today is one in three Americans

Ashish Jha: 00:01:58

have benefited from this. You may be one of them have gotten one of these preventive services. Didn't have to pay anything out of pocket. One in three for all Americans who have employer sponsored health insurance, one in two women have benefited from this. I suspect a lot of that is the free

Ashish Jha: 00:02:11

mammograms that women get and should be getting, because when they have employer sponsored health insurance, mammograms are covered for free. That is now under attack, and we will see where the courts land on that. So that's your number for the day one in three.

Ashish Jha: 00:02:29

All right, let's talk about a study as a little bit of an older study, but as we're at Earth Day, I thought this was a study worth taking a minute to talk about. The study is entitled, proximity to major roadways and asthma symptoms in the school inner city asthma study. It's in the Journal of

Ashish Jha: 00:02:49

allergy and Clinical Immunology back from 2020 now, a lot of studies that came out in 2020 and 2021 if they weren't about COVID, didn't get much attention. This was a really important study done by a group of Harvard researchers, and let me tell you why this is such a cool study and has caught my

Ashish Jha: 00:03:03

interest, and I've been thinking about this study for a long time. They looked at kids and looked at kids who developed asthma symptoms, and basically asked a simple question, Do you live near a major roadway? Do you go to school near a major roadway? And what they found was that kids who lived, who lived

Ashish Jha: 00:03:22

or went to school near a major roadway, had substantially higher rates of asthma, and for every 100 meters they were further away from a major roadway, they had about a 29% fewer odds, lower odds of developing asthma symptoms over the past couple of weeks. Let me explain why I think this is so

Ashish Jha: 00:03:40

important. Obviously, asthma is driven by a lot of environmental factors. We think about kind of air pollution more broadly, but it turns out, and this study, and there's other data out there, suggests that actually air pollution from cars, from internal combustion engines, that air pollution is actually

Ashish Jha: 00:03:58

contributing to the asthma that we see in children, and the further away children are from major roadways, the less likely they are either their school or their home, the more the less likely they are to develop asthma. It's actually a great example of what you can do locally. So we all think about

Ashish Jha: 00:04:16

reducing air pollution kind of more globally or even nationally when cities work on these issues, when you get more electric vehicles, where you take major roadways and put them away from schools, they have big benefits for children, and it reduces asthma symptoms, probably reduces emergency room

Ashish Jha: 00:04:33

visits, probably has a lot of cost benefits, but most importantly, has health benefits. So tailpipe emissions from cars probably an important source of triggering asthma in kids, and the more we can reduce that, the better. All right, so that's your study of the day. That's again, it's a little bit

Ashish Jha: 00:04:50

of an oldie, but it's a goodie, and it's a really important study, particularly as you think about Earth Day you.

Ashish Jha: 00:05:02

Okay, now to the one question, and to answer the one question of the day, I have asked my colleague, literally in the door, next, right next door to me, Francesca Beaudoin, who is the academic dean of the Brown School of Public Health, professor of epidemiology, somebody who studies the opioid

Ashish Jha: 00:05:18

epidemic and is a researcher extraordinaire, to come join us, and I'm literally going to have her come and join me. So Francesca, come on over. Hi. Here's my question for you, opioid epidemic, it's been awful. It's been getting worse and worse. We saw some numbers more recently overall. How do

Ashish Jha: 00:05:38

you feel like we're doing with the opioid epidemic? Are we making progress?

Francesca Beaudoin: 00:05:41

Haven't changed my answer. What's your answer? I actually think what is being called a changing of the curve, a pivot point, I think is really a flattening. So flattening, I think it's a flattening. We

Ashish Jha: 00:05:56

are down like almost 25% from last year. I mean, 23 to 24 How is that not like serious progress? Do

Francesca Beaudoin: 00:06:04

you think 80,000 plus people dying every year of an opioid overdose? Is that acceptable? No,

Ashish Jha: 00:06:12

it's terrible. But I didn't say, Is it acceptable? Like no one dying from opioid overdoses? Is acceptable? But isn't it better? Aren't we doing better? So

Francesca Beaudoin: 00:06:21

you're a data guy, you've looked at these curves. I have what happened after the pandemic? Well, what do you mean, like with with death, they have come down. So after a pandemic, probably slate, slight. I'm gonna, I'm gonna say slight. You're doing 25% slight, coming down. We saw

Francesca Beaudoin: 00:06:39

right in 2020 probably. And I think what we're seeing now is just like a correction to what happened in 2020 so if we actually where we are now is probably right where we are pre we're back to pre pandemic levels. Okay, okay, so

Ashish Jha: 00:06:54

it's not, if you take a broader perspective, it's not great. It's not but it does, least in the short run, looks like it's starting to turn the corner. Let me ask

Francesca Beaudoin: 00:07:02

you, I think there's some reason to be optimistic. I don't want to be a naysayer for some changes that I think have been really positive. So

Ashish Jha: 00:07:09

that's what I want to ask you. I know I get to ask one question, but I'm gonna ask a second. Why do you think we've at least flattened or maybe started turning the corner? What's driving that?

Francesca Beaudoin: 00:07:19

I think increased access to medications, medications for opioid use, disorders of methadone, buprenorphine, were doing a little bit better, although probably among the people that need those medications, maybe a quarter are getting them. There's actually some good data,

Francesca Beaudoin: 00:07:34

definitely, far less than half of people that need those medications are getting them. I think we've seen reductions in stigma, increased access to Naloxone, the antidote for an opioid overdose. But you know, year over year, drug overdoses continue to be the leading cause of death of American adults,

Francesca Beaudoin: 00:07:57

particularly between the ages of 18 to 50. It used to be car accidents, yeah, the first time that change happened was in 2011 Yeah. And we not that I want more people to be dying in car accidents, yeah. But we have not corrected that trend, yeah. And we are still, I mean, 20 years ago, a fraction of people that

Francesca Beaudoin: 00:08:15

are dying today of opioid over soon as we're dying of opioid overdoses. That's why I say, I think we've flattened that we've kind of corrected to pre pandemic levels. We're not where we need

Ashish Jha: 00:08:24

to be, yeah, and this is nothing to celebrate. Is your point, which I think is a fair point, you know, like I have on social media and elsewhere, sort of talked about like we're really making progress, and you're trying to temper that and say maybe a little, but we are still so far

Ashish Jha: 00:08:36

from where we need to be, and it's so historically abnormal where we are today, that this is no moment to celebrate. Is that a fair description of I think we're

Francesca Beaudoin: 00:08:45

approaching, since this epidemic was declared. I mean, we're approaching a million people who have died of an opioid overdose.

Ashish Jha: 00:08:54

That's awful. That is awful, and the biggest killer among young people, yeah, yeah, that's pretty awful. Since I have you here, if you could wave a magic wand and, like, make policy stuff happen, what are, like, three things you would do to drive these numbers substantially lower.

Francesca Beaudoin: 00:09:12

I'd still like to see increased access to medications. There is, I mean, methadone is a medication that is very, very effective is highly regulated, and lots of people don't have access to it. And even when they do have access, they don't use it because of the barriers for most

Francesca Beaudoin: 00:09:31

for people that don't know if you want to get started on methadone to help treat addiction related to opioid use, fentanyl use, you typically need to start going to the clinic, and every day, you have to show up every day. Typically, these clinics have really early hours in the morning. They're open

Francesca Beaudoin: 00:09:48

from five to 10 in the morning. They are not easily reached by transportation in a lot of urban areas, and people have to show up every day to get life saving medication. We don't ask people to do that for any other. Chronic health condition. Yeah, increasing access to methadone and deregulating methadone,

Francesca Beaudoin: 00:10:05

giving people access to methadone through perhaps their primary care physicians, being able to pick it up at a pharmacy, I think that would be a game changer. It's a more nuanced discussion than that, but there are discussions being had. There's bipartisan support for that. I would love to see

Francesca Beaudoin: 00:10:18

that happen. We need to increase access to medications, particularly in rural areas. The whole middle of the country, I think, has really poor access to medications for opioid use disorder, both methadone and Suboxone. And then I would love to see increased just overall treatment access addiction is so

Francesca Beaudoin: 00:10:40

widespread. I think anybody that's listening to this probably knows somebody that is suffering with addiction and opioid use disorder and other substance use disorder, and if anybody has tried, for themselves or with a family member to navigate that system and to actually get access to

Francesca Beaudoin: 00:10:56

treatment, it is hard. This is like we are in a behavioral healthcare crisis, and we need to do a better job with just widening treatment access as well as payment for that. Yeah. Okay,

Ashish Jha: 00:11:08

so little reason for optimism is still lots and lots and lots of work to do. The little bit of progress we've made has been because of improvements in access to medicines, more naloxone. But your point is, if we treated any other chronic disease this way, we would have horrible rates of

Ashish Jha: 00:11:24

compliance for diabetes and high blood pressure. We don't we treat those very differently. We have got to make this work easier and better. And I'm I suspect a lot of the extra stuff we make people do is because of still the stigma and the old ways that we have thought about these things. If we treat this

Ashish Jha: 00:11:39

as a bit more of a chronic disease, and use our chronic disease system, not that that's a perfect system, but let primary care physicians prescribe this, let people pick up more than one day supply of their medicines that we can actually make progress.

Francesca Beaudoin: 00:11:52

I mean, I think the Chronic Disease lens is the right one. This is a chronic disease. It is a chronic health condition. We just treat it very differently than we treat blood pressure, diabetes, congestive heart failure, yeah, partly because

Ashish Jha: 00:12:05

of the whole sort of mental model 100% around stigma and this idea that somehow it's a moral failure if you have a substance use disorder, absolutely all right. Francesca, thanks for coming by. Thanks for making the trip from over there and over here, but that was very helpful. I appreciate it. Thanks

Ashish Jha: 00:12:18

so much. My pleasure. All right, so that was it. That's our episode of moment in hell. Thank you guys again for joining us, and we'll be back again in the near future to share a data point, to talk about a study and to answer a question. All right, have a good one, everybody.