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The Exchange

A Different Lens

Drug safety expert G. Caleb Alexander and Clinton Health Matters Initiative CEO Rain Henderson focus on solutions to America’s prescription opioid epidemic.

Illustration by Yann Legendre

The statistic is as stark as it is frightening. Forty-four Americans die each day from prescription opioids. The Clinton Health Matters Initiative (CHMI), a Clinton Foundation initiative, has made finding solutions to the prescription opioid epidemic a priority, as have the Bloomberg School’s Center for Drug Safety and Effectiveness (CDSE) and the Center for Injury Research and Policy. Just before leading a November 2015 town hall at the School and releasing an expert report with more than 40 evidence-based recommendations for action, Rain Henderson, CEO of CHMI, and G. Caleb Alexander, CDSE co-director, discussed the epidemic’s genesis and strategies to reduce opioid-related injuries and deaths.

CA: There are so many challenges to optimizing the health of our country. Why did CHMI take on prescription opioids as an issue to tackle?

RH: We know that substance misuse is a huge and growing epidemic, and we see it just undercutting people’s economic prosperity, their mental health and well-being, and the ability for families to thrive. So we were watching the trends and seeing the data, and then simultaneously President Clinton knew three young people (whom he’d known since they were very small) who suffered from accidental overdose. It compelled us to look much more closely at the issue.

CA: Naloxone is so important to reversing overdoses that have actually happened, and it really can save lives. On the other hand, once someone is receiving or requiring Naloxone, to some degree the horse is out of the barn. How does CHMI think about primary prevention and about preventing new cases of opioid addiction?

RH: We have a focus on Naloxone because we think it’s important in terms of reducing the number of immediate overdoses, but we know we have to move much further up the prevention pipeline.

You can’t do anything within a perfect, isolated silo. That’s why we work at both a national and local level in communities where we have a focus on supporting systemic health improvement. We also work with partners focused on curricula and programs in K–12, college, and what’s happening with young people who are transitioning out of the home and are going into college, the workplace or perhaps the military. This goes beyond just substance use. It is looking at other, related issues when young people no longer have their peer groups, or they’re making a stressful transition.

Since we’ve started this work—I’ve never received so many personal calls from people I’ve known and worked with for 20 years, who say, ‘I’m so glad you’re working on this. By the way, I want to tell you my story.’

CA: There are millions of patients living in pain, some of whom raise concerns that efforts to reduce our over-reliance on prescription opioids may have a “chilling effect” on the quality of care that they receive.

RH: The best way to ensure that there’s not an oversimplification of these issues is to continue to include these stakeholders in the conversations and in the planning of additional forums and the rollout of these recommendations. I think we can figure out a path to move forward and that we don’t have to implement any of these recommendations at the expense of those who suffer from chronic pain.

CA: Did you see the [November 2, 2015] New York Times article that discussed the increasing rates of death among middle-aged white Americans without a college education? And it’s the only demographic in the United States where mortality rates have increased substantially over time. The authors attributed it, largely, to the opioid epidemic.

RH: This is a key topic at our upcoming Health Matters Summit, and I think it’s going to be a rallying cry for a lot of people who have not been paying attention to this epidemic. Because when you talk about drug addiction and drug users, they’re instantly stigmatized. [This research] is only going to help the work that we’re trying to do and to get people to look at this through a different lens.

CA: It’s remarkable, the amount of stigma that does exist toward prescription drug addiction and abuse. This morning I was speaking with someone, and they asked, “Why do people become addicted to these?” And I said, “Well, they’re highly habit-forming. It’s an inherent feature of the drug.” And they said that they thought, essentially, that it was a lack of willpower on the part of the individual. I think this is a very common perception still, despite the incredible amount of data and scientific knowledge that we have about the habit-forming nature of these products.

RH: I’m still surprised by it. Since we’ve started this work, I’ve never received so many personal calls from people I’ve known and worked with for 20 years, who say, “I’m so glad you’re working on this. By the way, I want to tell you my story.” We know what the data tells us about how pervasive it is, but if you asked everybody in the room to raise their hand if they know someone who has been affected, every hand would go up.

CA: So our report is, as you know, very comprehensive, and we worked hard to develop concrete and evidence-based recommendations for action. Let’s fill in the number: 42 recommendations. How do we move these to action?

RH: Our whole goal coming into this was to reach as many people as possible with real solutions. Because we’ve involved a broad range of stakeholders from the beginning, that informs the process, but it also informs the implementation, right? So we take that group of stakeholders, and we now expand it to the next tier of stakeholders to talk about the mechanics of implementation and start to prioritize where we think we have the most traction and readiness.

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