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Pain in the Nation: The Drug, Alcohol and

Suicide Epidemics and the

Need for a National Resilience Strategy

Benjamin F. Miller, PsyD, Chief Strategy Officer, Well Being Trust

John Auerbach, President and CEO, Trust for America’s Health
February 23, 2018
Trends in Alcohol, Drug and Suicide Deaths
New National Findings
 Death still increasing - 11% between 2015 and 2016
(our most recent data)
 142,000 died from the 3 causes
 Opioid deaths increasing most rapidly
 One death every 4 minutes
 Deaths could top 2 M in next decade
New National Findings - Opioids
 Deaths doubled from fentanyl, carfentanil
& other synthetic opioids - surpassing
prescription and heroin deaths
 Opioid Death rates among Blacks rose 58%;
Latinos up 35% (Whites still higher though)
 Death rates increased 33% among 18-34 year
olds (26% among 35 -54 year olds)
Geography and "Deaths of Despair" in 2016

 States with highest "despair"

death rates: West Virginia,
New Mexico and Alaska
 States with fast growing
rates: DC, PA, DE, MD, NJ,
Ohio, Ill.
A Path Forward: State & Local Public Health Perspective

 Evidence growing but uneven

 No single approach is sufficient:
 Changing characteristics (e.g. synthetics vs. prescription;
populations affected)
 Complexity of factors - economic and educational
 Underlying social and emotional risks
 Danger: Treating only symptoms not underlying
A Path Forward: State & Local Public Health Perspective
 Opioid/alcohol addiction & suicide are public
health issues
 Multi-sectoral approaches needed
 Key collaboration with public safety & health care
 Other sectors, too: education (children/adults),
business, recreation, faith
 Public Health can serve as Chief Health Strategist
A Path Forward: a National Resilience Strategy

 Prioritize Prevention, Reduce

Risk Factors and Promote
Resilience in Children, Families
and Communities by limiting
trauma and adverse experiences,
which have the biggest long-term
impact on later substance misuse,
and promoting better mental health.
A Path Forward: a National Resilience Strategy
 Reboot Substance Misuse Prevention
and Mental Health in Schools by scaling
up evidence-based life- and coping-skills
programs and inclusive school
environments and increasing the
availability of mental health and other
Focus on Children

 Two-thirds of Americans report

having experienced an adverse
childhood experience (ACE) while
growing up — across all socio-
economic levels.
 Nearly 40 percent experienced two or
more ACEs, and 22 percent
experience three or more ACEs.
National Resilience Strategy: Programs in Action
 Nurse-Family Partnership (NFP): works with at-risk young, low-
income, first-time pregnant women; has trusted relationship with public
health nurse, meets with mother from pregnancy until baby turns two.
 NFP has enrolled mothers early in their pregnancies and helped public
health nurses continuously conduct home visits over a two-and-a-half
year period.
 Provides a net benefit to society of $34,148 (in 2003 dollars) per higher-
risk family served, totaling a return of $5.70 for every dollar invested.
The ROI of a National Resilience Strategy
Learning from history
 Un-burying the lead: Public health tools are the key to beating the
opioid epidemic.
 Utilize Medicaid to reimburse supportive housing programs that co-
locate employment, education, and health services.
 Promote and finance two-generation, family-centered treatment and
support for children under foster and kinship care.
 Involve community leaders in designing preventive systems for younger
children to promote healthy behaviors, social skills, community
opportunities, and pro-social involvement.
A Path Forward: Health Systems Perspective
 Develop financial incentivizes for health systems to
promote non-opioid pain treatment options for non-cancer
 Integrate mental health into primary care throughout the
health system.
 Integrate suicide prevention into primary and behavioral
health care (e.g. Zero Suicide).
A Path Forward: Health Systems Perspective
Integrated sites: 39 percent
received some type of substance use
treatment in integrated sites

Non-integrated: 16.8 percent

received substance use treatment in
non-integrated sites
A Path Forward: a National Resilience Strategy
 Improve Pain Management and Treatment
by helping people heal physically, mentally and
emotionally. Approaches must acknowledge that
there are different types of pain and experts from
mental health, medical care and other disciplines
must develop team-based solutions that focus on
proactively addressing pain before it gets worse.
A Path Forward: a National Resilience Strategy

 Stem the Opioid Crisis with a full-scale approach – including

promoting responsible opioid prescribing practices (such as provider
education and best practices for Prescription Drug Monitoring
Programs); public education about misuse and safe disposal of
unused drugs; "hotspot" intervention strategies; anti-trafficking to
stop the flow of heroin, fentanyl and other illicit drugs; and
expanding the use and availability of rescue drugs, sterile syringes
and diversion programs.
A Path Forward: a National Resilience Strategy
 Address the Impact of the Opioid Epidemic on Children – and the
Need for a Multi-Generational Response that includes substance use
disorder treatment for parents and wrap-around services for children and
families, including grandparents and other relatives who help care for
children, and expand support for the foster care system.
A Path Forward: a National Resilience Strategy

 Lower Excessive Alcohol Use through evidence-based policies,

such as by increasing pricing, limiting hours and density of alcohol
sales, enforcing underage drinking laws and holding sellers and hosts
liable for serving minors.
A Path Forward: a National Resilience Strategy
 Prevent Suicides by expanding crisis
intervention services; anti-bullying and
social-emotional learning in schools; and
support systems for Veterans; and better
integrating mental health into primary care.
A Path Forward: a National Resilience Strategy
 Expand and Modernize Mental
Health and Substance Use Disorder
Treatment Services – Toward a Goal
of Focusing on the "Whole Health"
of Individuals by prioritizing
innovative integrated delivery models
for rural and underserved urban areas
and expanding the provider workforce,
including those who can deliver
medication-assisted treatment.
Suicide Deaths and Primary Care Visits
National Resilience Strategy: Programs in Action

 Bexar County Jail Diversion Program aligned its criminal justice

system, hospital, mental health services and community partners to
transform the mental health system into one focused on diverting
people with serious mental illness away from jail and toward
 This effort successfully diverted over 100,000 adults from jails and
emergency departments and resulted in a cost savings of nearly $100
million over an eight-year period.
National Resilience Strategy: Programs in Action

 The Zero Suicide Initiative requires primary care doctors to screen

every patient during every visit with two questions:
 How often have you felt down in the past two weeks?
 How often have you felt little pleasure in doing things?
 High scores lead to further questions about sleep
disturbances, changes in appetite and/or thoughts of hurting
 The model led to an 80 percent reduction in suicide.
National Resilience Strategy: Programs in Action
 Our report highlights more than
60 research-based policies,
practices and programs.