The opioid crisis has been dominating headlines every day here in the United States. This crisis has shown no boundaries when it comes to age, race, ethnicity, or socioeconomic groups. It has made its way into households, hospital emergency rooms, courthouses, as well as schools and universities across the country, not only directly affecting hundreds of thousands of people, but their families, loved ones, and communities as well.
“This crisis kills more individuals every year than car accidents or guns,” stated Dr. Scott Weiner, director of The Brigham Comprehensive Opioid Response and Education Program during the iHub Speaker Series and HealthCheck Collaboration event “Solving the Crisis with Opioid and Pain Innovations” hosted on April 2 at the Brigham. “To date the death toll is greater than the peak of the AIDS epidemic and has killed more people than the Vietnam war.”
Recently, local community and government officials have been looking to health care professionals to help address this crisis at the front lines, as well as look into how we can prevent this occurring in the future. These experts have been working tirelessly to create more effective tools, processes, and overall initiatives hoping to aid those who are currently suffering, and prevent those coming into the hospital from becoming addicted to opioids in the future.
In Massachusetts alone, the state has averaged 2,000 deaths per year, but has recently seen a slight decrease. “However, there is still so much more to do. We need to think about how we can use innovations, technology and this new spirit we have– because we are all in a unique position where we have the ability and the duty to address this,” urged Weiner.
At the April 2nd event, the Brigham Digital Innovation Hub and MassChallenge HealthTech brought together experts from across the Brigham and the Boston community to create an open environment to discuss the current state of the opioid crisis and share their insights, current innovations and initiatives, and how they believe innovation and technology can help us move forward to a brighter future.
The event kicked off with a powerful keynote from Jack Kelly, author of Sharp Needle, and a diverse and dynamic panel featuring Hannah Maniates of Mayor Martin J Walsh’s Office of Recovery Services, Satya Prateek Bommaraju of Marigold Health, Dr. Christin Price of Brigham Health Bridge Clinic, and Dr. Joji Suzuki, an expert in addiction psychiatry at the Brigham. The panel was moderated by Felice Freyer of the Boston Globe.
We can’t do it alone: How collaboration and innovation will result in more promising solutions
Bringing together a diverse group of panelists to speak about these issues gave us an expanded view into the promise of collaboration, as well as further insight into where gaps are still causing us as a community to not be able to move forward.
“We need to build collaborations across the various touchpoints, where we can track patients throughout all stages of care,” stated Bommaraju from Marigold Health. Marigold Health, a member of the 2019 MassChallenge HealthTech cohort, is a mobile platform giving patients text-based group support, while using artificial intelligence to scale existing behavioral health providers.
“Data is power, and the various points of connectivity are crucial in health care. The crucial factor is how do we build these collaborations and connect these startups,” urged Bommaraju.
Bommaraju also highlighted other members of the MassChallenge HealthTech 2019 Cohort that are leading the charge in this space, such as DynamiCare Health, a technology platform that addresses substance use and rewards healthy behavior. He pressed on the importance of AI-based voice assistants and chatbots such as CareAngel and Bouy Health as ways of engaging patients in their existing continuum of care.
“We should leverage all of the data we have, breakdown the silos and actually make those connections,” urged Price.
Maniates discussed how the City of Boston is working to provide resources to support patients. “The City of Boston has opened an engagement center to support patients in 2015. Before then, people didn’t know where to go for care. Now, our office provides gaps in patient care and works to provide access to resources and services.”
Cities like Boston, which are fortunate to have not only many large academic medical centers in close proximity, but affiliations with leading academic institutions and leaders in the tech space, also have the ability to share their models with those in more rural or isolated areas in order to help them address their issues on a local level as well.
“Technological innovations and things like telehealth and virtual visits can take a model like the Bridge Clinic and scale it to remote areas as well as provide ongoing care," stated Price. “Being able to virtually see patients can give us at the Brigham, as well as other institutions, the ability to scale models we know are working.”
The Brigham Health Bridge Clinic, which celebrated its one-year anniversary the day of the event, aims to bridge patients with substance abuse disorders being discharged from the hospital and emergency department to the long-term care they need. “They can start their treatment right here in the hospital, as soon as they leave the ED.”
Working and collaborating closer with groups such as Dr. Suzuki’s at the hospital has also given the Bridge Clinic a unique advantage. “We have recovery coaches on site to stay with the patient. We have the ability to also co-treat mental illness as well as the substance abuse disorder, which makes us different than other Bridge Clinics, such as Mass General Hospital and Boston Medical Center.”
The power of community: understanding how local community can support patients
Although the panel acknowledges that many people in the broader community are skeptical about the use of technology in the space, several panelists see promise in using technology as a tool to connect individuals in the community with the care and support they may need to be successful in recovery. “I think there is still a lot of social isolation, as well as stigma around these issues,” stated Maniates, referring to some of the issues in her hometown of Meadville, PA. “I think technology can be used to break down some of that isolation and some of that stigma.”
Bommaraju shared specifics around how the startup is making strides towards improving patient support during their recovery. He explained that users of the application can join groups with anywhere from five to seven peers, open 24/7, and can talk anonymously without the fear of stigma or judgement.
“Our mission is to drive patient engagement while improving care,” explained Bommaraju. “We have AI algorithms that can identify if users are at risk of relapse or suicide ideation.” Working closely with providers, Margiold Health can help track patients, gain further insights into their progress and assist in identifying anyone who may need more attention.
The City of Boston is a focusing on the impact of opioid addiction on the younger generation. The Youth Substance Use Prevention Strategic Program aims to assess the capacity of existing youth substance use prevention services, identify gaps and best practices for expanding youth prevention service capacity and develop actionable recommendations for future investments in youth substance use prevention services that are culturally competent and linguistically appropriate. “We are educating those who come in regular contact with young people on how to teach positive coping skills, how to talk to them about opioid medications, and helping them overall interact with these young people,” stated Maniates.
The emphasis on the younger generation came through Q and A with the audience, in which many answers emphasized how hospitals and cities are making sure this generation is correctly educated, supported and heard when it comes to opioid and other pain medication. “There must be further implementation in schools to reach kids at a younger age. Programs such as D.A.R.E did not work,” urged Suzuki.
Many within the system are still concerned about equal access to care, and the socioeconomic divide that causes a lot of the underlying issues and disorders which can then transform into substance abuse and addiction. “Until we change the communities that our patients are living in, which produce chronic stress, we will not be able to address addiction. We need to address violence, racial inequity, and other issues in order to address this crisis,” stated Price.
Patient care: showing support through hope and compassion
Despite the vast population that has been affected by this crisis, there is still much stigma and stereotyping around the issue. Jack Kelly, author of Sharp Needle, delivered a powerful keynote, in which he discussed his experience as a former addict. “My story isn’t much different than people you know in your life. I was a middle-class kid, grew up right here in Boston,” explained Kelly. “I was given all of the opportunities that one would like their parents to give.”
His journey began at 13 years old, where he was prescribed a large amount of Percocet after separating his shoulder in a hockey incident. Kelly highlighted his personal lack of understanding around opioid pain, the lack of knowledge and transparency that his doctor had into his family history of addiction and substance abuse and his eventual transition of becoming “an addict” within a six-month window.
“For me, there was before the needle and there was after the needle,” he explained. “It was within that 20 minutes [of his first recreational experience with opioids] that I knew I wanted to be nowhere else in life. I didn’t care about hockey anymore. All I cared about was getting high.”
But Kelly was luckier than others. He shared his experience and eventual transition to recovery while staying at the Boston Rescue Mission.
“It was at the Boston Rescue Mission where I was given compassion. I was treated like a human being. I wasn’t looked upon as if there was something wrong with me.” He said that compassion plus opportunity offered him hope to overcome addiction. “The fact that somebody was willing to give me an opportunity that was going to pay well, and give me self-esteem, be a part of a union and do good work; that to me was so critical. It was the fact that somebody gave me hope. Someone believed in me.”
In response to this, Maniates explained the various programs and initiatives being implemented at the city level which supply small seed grants for those in early recovery for workforce and education support. “So if someone can get a union job, but can’t afford their boots, we can help with that,” she explained. “If someone gets a scholarship to school, but can’t afford to get their books for school we are going to work on those issues.”
Kelly urged the audience of providers and caregivers to offer support through hope and compassion to patients like him. Stigma won’t help tackle the issue. Talking about it is the first step towards tackling this massive challenge in health.
“It is not enough to keep someone clinically stable; you must also treat them as a person. Tell them there is more that you can do in life, than just be this. Your life is not over, and it is not limited.”
Change of mindset and care will result in an impact on the opioid crisis
So how do we move forward? Many lives have been affected and it will take continuing collaboration, giving compassion, and connecting and supporting the community to see improvements, and it all begins with an open dialogue around this issue. “I see hope in the fact that people are openly talking about these issues,” explained Maniates.
Dr. Price explained that this specific event between with the Brigham and MassChallenge HealthTech was a first step towards change. “This event was a starting point towards making strides and improvements because we are having conversations. We now have the resources that can prevent addiction from starting, as well as great models to treat addiction when it has occurred.”
Announced at the event were two new initiatives that will support the various internal innovators, projects and initiatives both at the Brigham as well as the broader Boston community.
“Pain and opioid related issues cut across multiple departments here at the Brigham. Were officially announcing the Brigham Program for Opioid and Pain Innovation and are actively recruiting a senior program manager to help us lead the initiative,” explained Weiner.
Working closely with iHub’s Brian Mullen, and various internal leaders at the Brigham, this announcement represents a two-year journey of convening various innovators in the space here at the Brigham to collaboratively work together, move forward toward better patient care, and work toward the goal that if you come to the hospital with an acute painful condition that you will be treated with compassion, and not be put at risk for opioid use disorder.
Weiner was also excited to announce donor commitment from the Donald C. McGraw Foundation to support research for innovative opioid and pain related projects here at the Brigham.
“This is a big issue that we need to solve with outside of the box thinking, and innovative ways to do it, and I believe that we can,” stated Kelly. “If we can go to the moon, we can solve this.”