Community health & investment

The use, dependence on, and abuse of opioids have grown substantially in the past decade nationally, and in New York State. Across New York, the morbidity and mortality associated with opioid overdose have also increased substantially from 2010 to 2015:

• The age-adjusted rate of all opioid overdose deaths per 100,000 population doubled.
• The age-adjusted rate of opioid pain reliever deaths per 100,000 increased 1.6 times.
• The age-adjusted rate of heroin deaths increased by over five times.

In New York City, while the age-adjusted rate of heroin-related overdose deaths per 100,000 population increased almost five times from 2010 to 2015, the age-adjusted rate of opioid pain reliever-related overdose deaths over the same time period barely increased.

Northwell Health is a major health care provider in six out of the seven counties in New York with the highest death rate involving opioid use (CDC 2016).

The Commonwealth Fund has found that the sharp increase in overdose deaths over the last half-decade has split into two distinct epidemics based on the type of drug and affecting different demographic groups. The prescription drug epidemic primarily occurs among older adults in rural and suburban, predominantly-white communities.

The second, more nascent epidemic stems from illegally produced opioids (e.g. heroin, fentanyl, and fentanyl analogues) that are more commonly used by younger individuals and increasingly, those in urban communities of color. Additionally, as state and federal lawmakers, law enforcement officials, and health care providers successfully restrict illicit access to prescription opioids many opioid-dependent people have transitioned to using illegal heroin and fentanyl, representing a convergence of the two epidemics.

Early and ongoing interventions to stem the prescription drug epidemic has focused on clinical determinants related to providers’ approach to treating pain, aggressive marketing by pharmaceutical companies, an increase in chronic pain prevalence, and limited access to less addictive painkillers and medication-assisted treatment options. Despite a decline in opioid prescribing nationally by 13% between 2012 and 2015, however, national overdose death rates attributed to opioids have surged 38% during those same years—a rise mirrored by New York State and New York City data.

Multiple social, economic, and structural forces contribute to the opioid epidemic in general, and to this rise in the mortality and morbidity related to an overdose of illegal opioids. These include unemployment and a lack of economic opportunity; residential instability; eroding social capital; limited access to physical and mental health services; unaddressed childhood trauma; poor health literacy and education; and a punitive criminal justice system that detracts from treatment and instead, enhances stigma.

Northwell Health is uniquely positioned to examine and address this opioid crisis afflicting our communities and to anchor a comprehensive, collaborative, and coordinated strategy to change its trajectory. Focus areas:

• Clinical Determinants through the Opioid Management Steering Committee. 
• Community Investment through Social Determinants of Health, Community Partnerships, Social Equity and Policy and Advocacy

To quell the progress of the epidemic, however, a more holistic approach that includes addressing the nonclinical needs of both the individual and community is necessary.

• Leverage the data capabilities of Northwell Health to empower communities to identify, build, and implement evidence-based, sustainable, and self-sufficient solutions to address the unique social determinants of their opioid crisis.
• Build partnerships and strengthen relationships with other stakeholders in the community (state and local governments, law enforcement agencies, schools, community organizations, employers, and families) while serving as an anchor to coordinate clinical and community resources in an effort to disseminate best practices, collaborate on interventions, and maintain accountability. 
• Utilize our widespread clinical care network to expand care management and care coordination in the treatment and management of opioid addiction and chronic pain.
• Advocate for policy changes to city/state regulations to avoid failed strategies, such as the over-criminalization of the epidemic, which drive people away from care and treatment, and exacerbate disparities.

Example in progress: Tracking the Opioid Epidemic and Accelerating the Response on Staten Island

Staten Island is among the boroughs hardest hit by the opioid crisis. In February 2018, the Office of Staten Island Borough President launched a data-driven strategy to engage the community and leverage experts to take a comprehensive look at the opioid crisis on the island. Our goal is to identify a core set of measures to guide and align all of the work currently being done by various stakeholders in the borough.

Northwell Health, as the leading healthcare system on Staten Island, was engaged to help the borough address the crisis by:

• Working closely with the Office of the Borough President to ensure this 90-day initiative was comprehensive in its approach and strengthened collaborations with clinicians, community-based organizations, government, and criminal justice officials in the borough;
• Helping to engage the Bloomberg American Health Initiative at the Johns Hopkins Bloomberg School of Public Health, national experts in developing similar data-driven processes that prioritizes and coordinates current initiatives;
• Demonstrating how when a healthcare system strategically invests its community benefit resources, it can improve the health of communities.

In partnership with New York State, the Office of the Staten Island Borough President, Northwell Health, the Columbia University Mailman School of Public Health and the Columbia University School of Engineering, the Consortium for Affordable Medical Technologies (CAMTech) organized the Empire State Opioid Epidemic Innovation Challenge for a diverse community to co-create solutions that have the potential to change the trajectory of the local and national opioid crisis.

On September 28-29, 2018, over 200 people attended the Challenge Summit and Solutions Sprint to identify unmet needs in the opioid epidemic and co-create solutions to address those needs. The Opioid Solutions NY Demo Day will be on January 31, 2019, when teams compete for $10K and six months of acceleration support in the CAMTech Accelerator Program.