PAF: Opioid Epidemic

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By Joshua Feld­man, So­phie Feld­man, Han­nah Mar­morine, Nishant Up­pal, and Eric Gast­friend.

This is the Ex­ec­u­tive Sum­mary of the fi­nal re­port from a Philan­thropy Ad­vi­sory Fel­low­ship pro­ject, part of the Har­vard Univer­sity Effec­tive Altru­ism Stu­dent Group, to re­search in­ter­ven­tions to com­bat the opi­oid epi­demic in the U.S. The full re­port is available here. This re­search was con­ducted on be­half of PAF client Laura and John Arnold Foun­da­tion.

Sum­mary of Recommendations

In this re­port, we eval­u­ated in­ter­ven­tions to com­bat the grow­ing opi­oid epi­demic in the United States. We de­vel­oped a method­ol­ogy for eval­u­at­ing in­ter­ven­tions based on 3 key crite­ria: ev­i­dence, cost-effec­tive­ness, and scal­a­bil­ity. We also cre­ated a scor­ing rubric to sim­plify our con­clu­sions on the strength of the in­ter­ven­tions in each of these 3 ar­eas. We looked at in­ter­ven­tions in 5 broad prob­lem ar­eas: pain treat­ment, opi­oid sup­ply, ad­dic­tion treat­ment, ac­cess/​refer­ral to treat­ment, and harm re­duc­tion. There are many more in­ter­ven­tions and prob­lem ar­eas that de­serve con­sid­er­a­tion but fell out­side the scope of our pro­ject (e.g. crim­i­nal jus­tice, drug policy). Our re­search was based on ex­pert in­ter­views, read­ing re­ports and stud­ies, and our own Fermi es­ti­ma­tions when data was un­available. In par­tic­u­lar, we re­lied heav­ily on Phillips 2017 and Tick 2017 for as­sess­ments of the qual­ity of ev­i­dence, and on the Wash­ing­ton State In­sti­tute for Public Policy for cost-effec­tive­ness es­ti­mates. The scope of this re­port is to eval­u­ate a set of in­ter­ven­tions for ad­dress­ing the opi­oid epi­demic, but does not con­sider par­tic­u­lar or­ga­ni­za­tions im­ple­ment­ing these in­ter­ven­tions, or the best ways that philan­thropy could pro­mote these in­ter­ven­tions.

Our recom­men­da­tions are:

  • In­vest more effort in con­tin­u­ing this line of high-level, strate­gic philan­thropy re­source to bet­ter de­ter­mine where re­sources can be best al­lo­cated for the crisis.

    • Develop a for­mal model of the opi­oid ecosystem

    • Fund the Wash­ing­ton In­sti­tute for Public Policy to pub­lish more de­tailed cost-benefit analyses

    • Deepen and broaden the in­ter­ven­tion search be­yond what this re­port has started

  • Pain Treat­ment: Recom­mended Interventions

    • Chi­ro­prac­tic ma­nipu­la­tion for chronic back pain

    • Acupunc­ture for chronic back pain

    • Ex­er­cise ther­apy for chronic back pain

  • Opi­oid Sup­ply: Recom­mended Interventions

    • Opi­oids safe pre­scribing train­ing dur­ing med­i­cal school

  • Ad­dic­tion Treat­ment: Recom­mended Interventions

    • Com­put­er­ized CBT

    • Contin­gency Management

  • Ac­cess/​Refer­ral to Treat­ment: Recom­mended Interventions

    • In­pa­tient Ad­dic­tion Con­sult Teams

    • ER post-over­dose refer­ral to care

    • Level-of-Care Treat­ment Matching

  • Harm Re­duc­tion: Recom­mended Interventions

    • Drug Checking

  • Preven­tion/​Ed­u­ca­tion: Recom­mended Interventions

    • Preventure

The full re­port is available here. Please con­tact huea.stu­dent­group@gmail.com if you would like more de­tailed in­for­ma­tion con­tained in our re­search spread­sheet.