Preparing for the 2017 National Opioid Emergency

August 29, 2017

Thomas F. Hilton and Dennis McCarty

Never invest money you cannot afford to lose.
That admonition came from the late stock market expert, Louis Rukeyser, in his 1976 book, How to Make Money on Wall Street. This remains wise advice for anybody wanting to invest a sudden windfall. Financial planners will tell you that there are three things you can do with money. First, you can spend it. Spending is buying something that will depreciate over time like a car. Second, you can invest it. Investing is buying something that you hope will appreciate in time like stocks or a house. Third, you can let it sit in the bank for a rainy day where it may not do anybody any immediate good. Moreover, it might disappear on its own as states often recoup unspent funds.

Our opinion is that, while devastating right now, the opioid emergency is unlikely to last very long. We believe that it is risky to invest short-term opioid emergency funds in service expansion because once that funding is no longer available, you may not have the resources to serve your increased client load. This type of investment only makes sense with a solid plan for long-term capacity building, such as a funding commitment from municipal or philanthropic sources. Short of that, service expansion may do more harm than good in the long run.

Another option is spending on things like new computers for staff, upgrading software and servers, or redesigning your website. While all that stuff depreciates, it can also enhance efficiency, which could translate into increased capacity and the need for more future operating funds. Thus, some spending can become an infrastructure investment.

The challenge is how to decide; not just what to decide on. As the influx of added resources is likely to affect everyone in your organization, they will likely and rightly feel that they have a stake in its distribution. Managed carefully, the new resources can energize staff members if the way the funds are spent is perceived by all to be in the best interest of the organization and its clients.

Here are a few things you might consider doing – if opioid emergency funds become available:

Capacity: Set up a committee to explore how funds might be used to expand capacity knowing that resources will be finite. Meet with your state authority and determine how they plan to prioritize additional funds.

Outreach: Politics usually causes emergency funds to be wide spread and they may wind up in jails, courts, schools, churches, half-way houses, etc. Creating working groups to explore collaborating with other recipients might build some long-overdue bridges not fully developed due to lack of start-up resources. It may enable you to collaborate with local health centers and together build systems of care that included opioid agonist therapy with buprenorphine. Health centers often struggle with addressing opioid use disorder and may be willing to have your counselors see patients with disorders at their health center.

Needs Assessment:  Mike Dennis at Chestnut Health Systems has often noted that a great many people with alcohol and substance use problems are “multimorbid.” The new opioid crisis may have created a shift in client needs from previous years. They may need more careful monitoring for suicidality, education about what to do if they OD, help transitioning from long-term unemployment, or accessing more intense recovery support, such as Oxford Houses. The needs assessment should also consider the need for counselors skilled in assessing and treating co-morbid mental health disorders. You may be able to advocate for enhanced reimbursement so that your counselors can be paid better and you can recruit and retain counselors with the skills needed to treat complex patients.

Consensus Building: Once recommendations have been assembled, it makes sense to call an all-hands meeting to discuss options. The feedback from staff will help to optimize new expenditures, and likely build support for putting the funds to good use.

What would you do?  Share your thoughts in the comments section below.

About our guest bloggers:  

Dr. Hilton is a retired NIDA program official living in Indian Harbour Beach, FL. Dr. Hilton blogs frequently for the ATTC/NIATx Service Improvement Blog. 

Dr. McCarty is a Professor in the OHSU/PSU School of Public Health at
Oregon Health & Science University.

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