Treating the Opioid Crisis: Assessing Programs to Address Overdose Deaths in West Virginia

Problem Statement: Too many people in West Virginia are dying from opioid overdose. West Virginia’s current policies and regulations are insufficient in addressing the opioid epidemic. West Virginia had the highest rate of overdose deaths in the country in 2016, that being 881 or 52 deaths per 100,000 people (“Drug Overdose Death Data”, 2017), and it is costing the state an estimated $8.8 billion per year (Eyre, 2018a). To address this issue, four different policy alternatives have been formulated in an attempt to decrease the number of opioid overdose deaths in West Virginia. These alternatives are allowing current trends to continue, increasing prescription opioid regulation, transforming the seven existing needle exchange programs (NEPs) into safe injection facilities (SIFs), and expanding Certified Community Behavioral Health Clinics (CCBHCs). Possible outcomes, tradeoffs, and limitations were projected for each policy alternative, and four different criteria were used to evaluate the policies and their outcomes. The projected outcomes that were considered for each policy alternative were saved productivity due to decreased overdose fatalities, saved productivity due to decreased opioid addictions, saved resources in the form of healthcare, substance abuse treatment, and criminal justice costs, and the cost of implementation. By subtracting the costs from the benefits, the net benefit of each policy alternative was evaluated. Four different criteria were then selected to evaluate each policy alternative holistically. These criteria were efficacy, efficiency, equity, and political acceptability. After considering the projected outcomes, tradeoffs, limitations, and applying the criteria for evaluation, the best policy to decrease opioid overdose deaths in West Virginia is a combination of expanding CCBHCs and increasing prescription opioid regulation. These alternatives aim to solve the opioid overdose epidemic in both the short and long term. CCBHCs were the most cost-effective policy, saving the state $437 million annually. With 24-hour crisis care, staff trained in life-saving naloxone administration, and same-day access, CCBHCs provide an immediate short term solution to opioid overdose deaths. Their other services such as outpatient mental health and substance use services, risk-management assessment, and targeted case management will decrease opioid addiction and overdose deaths in the long term as well. Increasing prescription opioid regulation will also be able to address overdose deaths in the long run, and aims to attack the root of opioid epidemic—prescription opioid abuse. Since 80% of heroin users transitioned from misuse of prescription opioids, limiting opioid prescriptions for acute pain to a seven-day supply will decrease the likelihood of continuous dependency. Enhancing West Virginia’s prescription drug monitoring program to include data sharing amongst prescribers, primary care physicians, law enforcement, and public health agencies provides a greater opportunity to identify individuals at-risk of developing an opioid use disorder, as well as unethical prescribers. With a cost of implementation of only $1 million, and a net benefit of $242 million, this policy is a worthwhile investment for the state of West Virginia. While either policy would succeed separately in decreasing the death rate due to opioid overdose, both policies in tandem is the most efficacious and efficient recommendation for addressing the opioid epidemic and decreasing overdose deaths in West Virginia.https://digitalcommons.morris.umn.edu/urs_2018/1004/thumbnail.jp