On the Front Lines of the Opioid Epidemic

By Kevin G. Sumner, MPH, NACCHO President and Health Officer and Director of the Middle-Brook Regional Health Commission in Green Brook, New Jersey

The opioid epidemic has claimed thousands of lives and engulfed entire communities, yet often feels too monumental to be seen as anything other than relentless and unending. But with as many harrowing stories that we have read and heard in regards to this profound public health crisis, there are also glimpses of hope: what’s working, the moderately sized successes that might work on a larger scale, and what adequately funded interventions look like.

According to the Centers for Disease Control and Prevention’s 2018 report, Morbidity and Mortality Weekly Report (MMWR), 47,600 Americans died because of opioid-related overdoses in 2017—far outpacing the mortalities associated with car crashes in 2017 and those of the peak years of the AIDS epidemic. Opioid misuse was declared a national public health emergency in October 2017, and the National Association of County and City Health Officials (NACCHO) affirms that local health departments (LHDs) play a critical role in responding to opioid misuse and overdose within their own communities.

Our LHDs are well-suited to serve as conveners or supporters of coalitions and partnerships. In the way that Public Health 3.0 points to partnerships as a key toward advancing a local public health department’s work, we know that collaboration at the local level is essential in addressing the multifaceted nature of the opioid epidemic. The coordination of federal, state, and local partners, along with the engagement of community agencies and organizations, is critical in implementing strategies to prevent and respond to opioid misuse and overdose.

Opioid use looks different across jurisdictions and communities. During a crisis, communities often focus on the biggest threat at hand: while some struggle to control prescription opioids, others may be battling an illicit supply of synthetic opioids. The economics, demographics, and cultural characteristics of a community shape its particular landscape of drug use; therefore, the community’s interventions for both prevention and response need to be appropriately local in considering resources and systems. As critical as a nationwide response is, specificity is needed for relevant and effective activities at the local level.

In New Jersey, we clearly see the diversity of issues and approaches. In some areas of the state, we have LHDs leading or collaborating with community partners to conduct routine, robust fatality reviews to identify the roots causes of problems and possible solutions. In other areas, local health has had little-to-no involvement and is just now finding their way toward a seat at the table. As such, we have noted the disparities across the state.

As a result, the New Jersey Association of County and City Health Officials, is currently in the process of conducting a statewide assessment to identify both gaps in knowledge and resources as well as what resources are available in our communities and for our local health departments. We will be revealing the results of this assessment at a statewide meeting in August, which will provide our LHDs with tools to advance their efforts and knowledge to better advocate for the needed resources.

LHDs are often at the forefront of conducting monitoring and surveillance activities, or supporting the implementation of prescription drug monitoring programs in collaboration with other agencies. By tapping into their role as educators and prevention experts, they can develop programs to raise awareness about the risks of overdose, educate the public and key stakeholders about drug use and harm reduction, and implement programs. Stigma around drug use remains prominent in communities across the nation, and many LHDs conduct activities to better understand, address, and reverse stigma, with the goal of improving outcomes for people who use drugs or seek treatment.

To support individuals living with OUD, LHDs can also develop treatment options, such as medication-assisted treatment, and can improve community linkages to care for OUD treatment, as well as for other physical and mental health services related to opioid use. They are also well-suited, with adequate funding, to support active drug use communities and to develop and enhance support systems for individuals engaging in treatment.

How Can We Support LHD Efforts?

Despite their critical role, LHDs are under-resourced to give the epidemic proper attention and often lack dedicated funding for opioid activities. The lack of dedicated funding for LHD opioid efforts is a feature of continued, across-the-board budget cuts to local public health. To mitigate the substantial threats of the opioid epidemic, an investment of sufficient and stable funding is essential if LHDs are to bolster their work-force and address the dynamic health needs of their communities.

A potential solution to support increased, sustainable funding streams for LHDs engaging in this type of work is a model based on the Ryan White funding structure for HIV/AIDS. Legislation based on this model, the “Comprehensive Addiction Resources Emergency Act,” has been proposed but has yet to be approved out of the Senate HELP Committee and brought to the floor for a vote. By ensuring sustainable and adequate funding, this type of legislation could support long-term, comprehensive programs and enhance workforce capacity.

There will always be another crisis, and the lessons learned from a variety of domestic drug use epidemics tell us that when we fail to prepare, we fail far too many. Instead of reactionary responses to each new public health emergency, LHDs have a unique opportunity to harness the national conversation around opioids to push for structural improvements in our official response to drug use of all kinds.

For NACCHO resources on the opioid epidemic, visit NACCHO’s Opioid Epidemic webpage.