Giving Compass' Take:

• Experts including David W. Murray and Senator Bill Cassidy discuss upstream interventions to prevent opioid addition to curb the opioid epidemic. 

• How can funders help stakeholders adjust practices and policies to prevent and improve care for opioid addiction? 

• Learn about a role for philanthropy in fighting the opioid crisis

David W. Murray: For many Americans, however, such standard medical interventions as surgery are also a substantial pathway for opioid initiation, which not uncommonly leads to persistent opioid use and misuse. Studies attest that, for opioid-naive patients undergoing a variety of surgeries, a substantial fraction will persist in using the opioids weeks later – 6-to-9 percent, depending the study and the type of surgery – after the surgery. Moreover, in some instances where patients were already opioid-experienced before they went into the surgery, the proportion of persistent users measured as much as a year after surgical intervention, 45-percent to 71-percent of those who were opioid-experienced are experiencing persistent refill use of prescriptions. Non-opioid alternatives are needed in medical practice to reduce opioid exposure beyond necessity. Opioid-sparing technology, medical practice and procedures and models need to be incorporated. Even under proper medical supervision, an extensive reliance on opioid medication for pain management presents several risks for patients, particularly at high doses continued for long periods of time.

Senator Bill Cassidy: I’m shamelessly stealing from a conversation I’ve had recently with a pain physician. She says, in her practice, although Medicare does not pay for it, when an elderly person comes in with a broken hip, they will do ultrasound-guided nerve blockage. And that ultrasound-guided nerve blockage eliminates the need for opioids. They may give a little bit of fentanyl at the outset before the block is in, but once the block is in, this incredibly painful condition is adequately treated. Medicare does not pay for ultrasound-guided pain blocks. If Medicare put forward a payment policy, in some situations in which they would do this, Medicare is the straw that stirs the drink: once Medicare has a payment policy for such a procedure, typically, commercial insurance will follow, then Medicaid, and then it now becomes common practice to do this, as opposed to giving an elderly person a bunch of opioids, which, genetically, a certain percentage of them are going to become addicted to.

Read the full conversations about upstream solutions for the opioid epidemic at Hudson Institute.