Substance Abuse Roundtable

On Thursday, May 26, J-PAL North America hosted a Roundtable on Addiction, Treatment, and Prevention. Policymakers, researchers, and J-PAL staff gathered to discuss innovative approaches to curtailing substance abuse. The event connected policymakers and leading academic researchers to develop evidence-informed policies and rigorous evaluations of promising new approaches.

Quentin Palfrey, Executive Director of J-PAL North America, began the day by recognizing the widespread harm of substance abuse nationally. Palfrey noted that it is critical that researchers and policymakers work together to evaluate interventions and implement the most effective approaches:

“Health officials and public health leaders are innovating to tackle drug addiction across the United States, at the local and national levels, while researchers are eager to rigorously evaluate which approaches are best-suited to face this problem. Through collaboration, we can better understand how to address the challenges of substance abuse.”

Joseph Doyle (MIT Sloan School of Management) reviewed a selection of global and domestic health research by J-PAL affiliates, and discussed his ongoing research with Mireille Jacobson (UC Irvine Paul Merage School of Business) and Padma Gulur (UC Irvine Health) on the health and financial impacts of involving pain specialists in the treatment of patients who already have significant previous exposure to opioids. Doyle noted that one in five patients admitted to the hospital is already receiving a high dosage of opioids.

Policymakers from Colorado, Massachusetts, Pennsylvania, and South Carolina then presented several innovative approaches to addressing substance abuse, focusing on prevention and rehabilitation. These included leveraging telemedicine to expand the scope of medication-assisted treatment (MAT), providing MAT to addicted inmates upon release from prison, a school-based universal substance use screening program, a program to support primary doctors treat patients with chronic pain. The policymakers shared a commitment not only to developing innovative strategies for addressing substance abuse, but also to rigorously evaluating their impacts.

Next, the event turned to presentations of substance-abuse related research from economists and physicians. Leila Agha (Boston University Questrom School of Business) presented her research on technology and innovation in health care, and Mireille Jacobson discussed several studies, including her ongoing work with Joe Doyle and Padma Gulur.

Presentations by Jane Liebschutz (Boston Medical Center, Boston University Schools of Medicine and Public Health) and Roger Weiss (McLean Hospital, Harvard Medical School) provided a medical perspective on strategies to address substance abuse. Dr. Liebschutz discussed her work on the Transforming Opioid Prescribing in Primary Care program (TOPCARE), which seeks to decrease misuse of and addiction to prescription opioids for patients with chronic pain. Dr. Liebschutz also described a checklist developed by Ariadne Labs (where she and Dr. Weiss are affiliate faculty) and the Center for Disease Control for prescribing opioids for chronic pain. Dr. Weiss discussed his work with the National Institute on Drug Abuse Clinical Trials Network (CTN), a partnership between academic research centers and community treatment programs (CTPs) to design and conduct multi-site clinical trials of drug abuse treatment in CTPs. Dr. Weiss also described the results of the Prescription Opioid Addiction Treatment Study, a randomized control trial that evaluated the impact of different lengths of buprenorphine-naloxone treatment and different intensities of individual drug counseling on patient outcomes.

Last, we heard from Katherine Klem, Senior Policy Advisor at the White House Office of National Drug Control Policy, on the potential value of Pay for Success contracts in financing innovative treatment and prevention interventions (see J-PAL’s evaluation of the Nurse-Family Partnership in South Carolina for an example of a PFS evaluation).

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After these presentations, J-PAL staff facilitated small group conversations in which policymakers and researchers discussed prevention and treatment strategies in-depth and explored possibilities for rigorous evaluation of innovative approaches.

Opioids and heroin have received national attention as they’ve become a major challenge for jurisdictions across the country. Some participants emphasized the importance of developing solutions to drug abuse more broadly, both to treat addiction among racial and other demographic groups that primarily use drugs other than opioids, and to develop the infrastructure that will be necessary to manage drug crises in the future. Dr. Weiss made a related point:

“If this were 30 years ago, we would be talking about the cocaine epidemic. Epidemics shift. We can’t lose sight of the fact that opioids are different from most other drugs because a) the central role of MAT [medication assisted treatment] for OUDs [opioid use disorders], and b) they’re prescribed drugs. But some of the features of opioid use disorders are the same for other substance abuse disorders. It’s important that if the opioid epidemic fades in the next five years, we aren’t left with opioid-focused interventions that can’t address the next epidemic.”

The roundtable represented a promising step in a pioneering collaboration between academic researchers and policymakers on the pressing issue of substance abuse, and J-PAL North America hopes to continue working on this challenge in the future.

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