Eagleton Institute leads workshop on ending the opioid epidemic

On the morning of Oct. 27, one day after President Donald J. Trump declared the opioid epidemic a national public health emergency, the Eagleton Institute of Politics hosted a timely workshop about multidisciplinary approaches to combating opioid abuse.

The event, entitled “Opioid Abuse: Searching for Solutions in Science and Politics,” was part of the Eagleton Science and Politics Workshop series and was open to current Rutgers graduate students, postdoctoral fellows and faculty. 

About 50 people from a wide array of academic and professional disciplines were in attendance.

The discussion was moderated by John Weingart, associate director of Eagleton, and featured four distinguished panelists: New Jersey State Sen. Joseph Vitale (D-19), Dr. Stephen Crystal, a Board of Governors professor of Health Services Research, Dr. Frank Ghinassi, president and CEO of Rutgers University Behavioral Health Care and Dr. Saira Jan, the director of pharmacy strategy and clinical integration for Horizon Blue Cross Blue Shield of New Jersey. Crystal, Ghinassi and Jan are all members of the Rutgers' faculty as professors.

A September article from NJ Advance Media reported that at least 1,901 people died from opioid overdoses in New Jersey last year.

“This epidemic is something that snuck up on us as a country, as a state, when we were looking through the rearview mirror,” said Crystal, who is also the director of the Center for Education and Research on Mental Health Therapeutics at the Rutgers Institute for Health, Health Care Policy and Aging Research.

Crystal said society created a whole generation of people with opioid use disorder, a phenomenon which he partly attributed to the “not very thoughtful” use of opioids in pain management in a system that is influenced by marketing.

“This is the only country besides New Zealand that has direct consumer marketing in drugs,” he said. 

As a result, the United States not only uses more opioids than any other country but also more psychoactive drugs in general.

One of the key things Crystal said he learned while developing the Center for Education and Research on Mental Health Therapeutics was how little is known in medicine and in policy about the use and outcome of drugs.

Vitale, whom Weingart described as “one of the leading thinkers and voices on health policy in New Jersey,” explained that while this is not a new problem in New Jersey, it was not until a few years ago that the epidemic fully entered the public consciousness.

“Early on in the discussion about opioid abuse, it was always ‘those <g>people’ — those</g> people in the shadows, in the alleyways, who live in a cardboard box, the poor, the people of color. It wasn’t ‘my kid,’ wasn’t happening in ‘my community,'" Vitale said. 

Then all of a sudden, in Monmouth and Ocean counties, there was a rapid rollercoaster of overdoses, he said.

“And everyone woke up,” Vitale said. “Now it’s in my community — now it’s in the white community, in suburbia, affecting the wealthiest and the poorest people I know and everybody in between.”

The panelists discussed the core principles of combating opioid addiction: prevention education, treatment and recovery.

“This is about as multidetermined a public health problem as you can imagine,” said Ghinassi, who has been involved in behavioral health and addiction since the <g>mid-70s</g>. 

He cited the many causes of the epidemic, from cultural stigmas associated with those who struggle with addiction, to the economic engines of pharmaceutical companies, as well as the <g>illicit</g> international drug trade.

Ghinassi also emphasized the need for a more robust understanding of the condition itself as an ongoing process. 

“Addiction has presented itself in the marketplace and in the behavioral health place as something that gets ‘fixed.’ The truth is, that like diabetes, like obstructive pulmonary disorder, and like recurrent depression, these are not one-fix disorders,” he said.

Following the panelist discussion, members of the audience were given the opportunity to comment or ask questions.

The event ended with an interactive activity in which the audience was divided into six small groups. Each group was tasked with examining a different level of government, ranging from the county level to the Governor’s Office.

Groups individually discussed policy options, available resources and plans for action then rejoined as a full audience to present and discuss their ideas with the panelists.

The panelists agreed on the necessity of decompartmentalizing different populations in society, as well as the many different social and medical factors which contribute to the state opioid abuse epidemic.

The wide range of solutions discussed by audience members and the panelists included providing better support systems for those leaving correctional institutions for drug-related offenses, legislation limiting the supply of opioids, such as the recent state legislation which limits initial opioid prescriptions to a five-day supply, accessing readily available data, such as the prescribing monitoring programs, which shows physicians which medications have already been prescribed to a patient and better public education.

Jan, in particular, stressed the necessity of developing education campaigns that speak to the younger generation.

She added that the legalization of marijuana in different states is sending a mixed message that the drug is safe to use.

“But they’re relating to the marijuana of the 80s when the THC level was far lower than what the THC levels are <g>now,</g>” she said. 

Jan explained that distributors frequently add fentanyl — a synthetic opiate pain reliever — to marijuana so that they become addicted.

Jan gave the example of speaking on a panel during a Model United Nations conference for 400 high schoolers. 

“There were a few parents standing in the back. I asked these kids, I said, ‘How many of you think marijuana is safe?’ Do you know 90 percent of the kids raised their hands,” Jan said. “You should have seen the faces of the parents.”

Another key theme was bridging the gap between academics and policymakers.

Vitale, who noted that no one in the New Jersey <g>Senate</g> is a healthcare professional, said, “It’s about connecting the dots and making sure that all the resources and the brainpower that we’re using to address this issue, somehow get connected — that there’s a roadmap of how to address this.”

"We have a road, though I don’t know if we have a map yet — it’s sort of in pieces everywhere...but everyone’s trying to find out what the gaps are and make sure it gets put together in the right way,” Vitale said.

The mission at Eagleton is to explore state and national politics through research, education and public service, Weingart said. There is a focus on how the <g>American</g> political system functions and how it can improve.

The workshop series, which began in 2015, aims to explore how scientists can effectively engage with the political process and to stimulate discussions about the intersections between electoral politics, government and the sciences, he said.

This session was the first Science and Politics Workshop of the 2017-2018 academic year, said Randi Chmielewski, the manager of Outreach and Special Projects at Eagleton. Two more sessions will be planned for the spring semester.

“We hope that the Eagleton Science and Politics Workshop sessions spark political interest, understanding and engagement and can help foster stronger connections with policymakers — and across disciplines,” she said.