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Hi, my name is Benjamin Linas.
I’m a Professor of Medicine at Boston University School of Medicine and I’m the Principal
Investigator at the SyndemicsLab at Boston Medical Center.
I’d like to share some of my work with you about ending the overdose crisis
in the United States.
Our group is deeply engaged with the HEALing Communities Study, and more generally the
HEAL Initiative.
And we focus on reducing the harms of drug use.
And therefore that HEALing Communities Study goal of reducing overdose mortality by more
than 40 percent in two years is really like a compass point for us.
However, we know that it’s not going to be easy and it is not easy to have such large
impact, and also through our work we know that real-world decision makers in communities
and towns around Massachusetts and the U.S. really have a lot of questions about how to
accomplish that goal.
It’s a lot easier to talk about a 40 percent reduction than achieve one, and we wanted
to be able to bring forward some concrete solutions that would provide a roadmap that
decision makers could use when they are allocating resources and making decisions.
So our vision for this work was to employ the Researching Strategies to Prevent Opioid
Death, or the RESPOND model, which is a simulation model of opioid use disorder and its treatment,
to experiment with different approaches to reducing overdose, to characterize combinations
of interventions that could lead to a 40 percent reduction in overdose in two years.
At the end of the day there’s three high-level takeaway messages from our work.
The first is that there is no single intervention that can end the overdose crisis.
To reduce overdose mortality substantially is really going to require all of the tools
in our toolbox, including initiating more people on medications for opioid use disorder,
improving retention in OUD care, and distributing naloxone.
There’s really no single strategy or any single venue that can reach the goal.
The second thing we found is that initiating people on medications for opioid use disorder
is definitely essential, but it’s not enough to end the crisis.
Beyond expanding the reach of medications, we also really need to find innovative and
effective strategies to improve retention on medications.
When you improve retention, that generates synergies with expanding access, and we absolutely
need to capture those synergies if we’re going to reach our goals.
And a third important message is that distributing naloxone, which is the reversal drug for overdose,
is essential to overdose prevention, but it’s not by itself adequate to reach our goal.
And I think that’s a really important message, because there are still some individuals and
communities and/or professional groups who remain ambivalent about medications for opioid
use disorder, and in some cases even oppose their use.
But this analysis makes absolutely clear that we cannot reduce overdose rates the way that
we want to without using medications for opioid use.
So treating addiction is not optional, and tertiary prevention with naloxone is not an
adequate response.
We do not have the luxury of picking and choosing.
And we’re going to need to work proactively and thoughtfully in order to achieve the goal.
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We undertook this work with the vision that the results would be truly useful to real-world
communities making decisions in real time.
And while we don’t think this is a precise crystal-ball projection of exactly what is
needed, it should be very useful to give a sense of how much work is left to be done,
how close is the community now, and how many more people would you need initiating and
retaining and how much more naloxone would you need in order to get to your goals, which
gives a strong sense, I think, of how much work there is to be done and importantly,
how much investment is needed to get there.
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I really think the NIH HEAL Initiative is one of the most important public health initiatives
of our time.
Our country is in the middle of a truly jaw-dropping overdose crisis.
The numbers of people who are dying every day and week in America from opioid overdose
is really unfathomable.
And the HEAL Initiative is our country’s real investment and major response to this
major public-health crisis.
I think one of its greatest strengths is that it’s brought together some truly innovative
and thoughtful people who care deeply about this topic, who’ve been working in this
space for years, and who now are bringing all of the tools of modern science and modern
medicine to bear to see if we can find a solution to this problem.
And we see our work as one step in that direction.
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