WASHINGTON -- Removing the stigma of opioid addiction -- including addicted medical professionals -- will greatly help in addressing the opioid crisis, Gov. Doug Burgum (R-N.D.) said at the National Governors Association (NGA) meeting here.
"If you're a licensed professional and have an issue like this, you're going to lose your profession," Burgum said Saturday at a panel discussion on the opioid crisis. "Some of the people we've lost in our state are in the medical profession; they can no longer get prescription drugs because of all the tightening on the drug prescription databases ... They're the ones that end up buying illegal street drugs and overdosing because they didn't want anyone to know in their profession that they had an addiction. We have to drop the stigma and be proactive about it."
The private sector also has to be part of the solution, he added. At a meeting of the state's opioid task force, which included doctors, nurses, pharmacists, and dentists, one participant noted that in his organization's electronic health record software, if someone was prescribing a pain reliever, "the first thing that came up was narcotics -- you had to page down like three pages to get to non-narcotics -- and it had a fixed dosage."
The organization flipped the order of the list so that non-narcotics were on top, and also reduced the size of an initial opioid prescription, "and the next week, prescriptions went down by 20%," Burgum said.
Culture change also is needed, said Gov. Rick Snyder (R-Mich.). He discussed the state's Angel Program, under which someone with a substance use disorder "can walk into any Michigan state police post and they're not going to arrest you -- they're going to connect you to an 'angel' to help get you treatment. This is a major statement about changing the culture to show that law enforcement can be a positive partner; we're encouraging other law enforcement agencies to do the same thing."
Provider education is also key, said Gov. Gary Herbert (R-Utah). "As we have met with our [state's] own doctors and asked, 'Why are you prescribing [opioids]?', their answer is, 'We didn't know; the information given to us was that this is not addictive,'" he said. "I think we're going to see a spate of litigation ... because of this information."
"I think our doctors are learning," Herbert continued. "They are being made aware to find alternatives to opioid prescribing."
Provider education is also playing a large role in Massachusetts, said that state's governor, Charlie Baker (R). "We now require everybody who graduates from medical school, dental school, nursing school, pharmacy school, and social work school to take and pass a class in opioid treatment and pain management," he said. "If you're a prescriber, as part of your continuing education for getting your license renewed, you have to take and pass a class in opioid treatment and pain management."
Massachusetts was also one of the first states to put a limit -- in this case, 7 days' worth -- on first opioid prescriptions, and it has "dramatically updated and modified" its prescription monitoring program, said Baker. "We've gotten to the point where the vast majority of prescribers are working on that system and using it as a search engine every time they write a prescription, and [the system] finally got to the point where it could start giving them information on their prescribing patterns relative to their peers."
"The other thing ... we've started to do is make physical therapy, acupuncture, massage -- a whole variety of alternatives to managing pain -- available," he said. "I do think that has potential, but it's one of those things that is going to require a very big community to change the way they've behaved for very long time, and that's probably going to take a while."
However, "Although people are doing a variety of things, we haven't seen a systemic approach to this [crisis]; this is a place where the federal government could play a real role," Baker added.
Oregon governor Kate Brown (D) agreed. "Right now, the federal government recognizes the problem, but from my perspective, is overly focused on punishment," she said. "That leaves us, the states, to address the issues that drive this health crisis while our prisons and foster care systems are filled to capacity with this problem."
Oregon is pushing legislation forward on a program -- similar to one now working in Massachusetts -- "to dispatch 'recovery mentors' who are highly trained people in recovery themselves, to emergency [departments] to connect with patients immediately and act as a peer, friend, and navigator on the next steps on the road to recovery," she said.
"I'm proud that people are treating this as the public health crisis that it is," said Brown. "It's critically important that ... we make sure we're comprehensively addressing behavioral health in our healthcare systems ... Making sure the federal government partners with us to provide healthcare for all our citizens is key to making sure people can get treatment and get into recovery, and [we need to] provide the support and services they need to lead healthy, productive lives."