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Horizon BCBS, DEA's Preventive Community Partnership to Combat NJ's Opioid Epidemic

Surabhi Dangi-Garimella, PhD
At a full-day event in Newark, New Jersey, drug enforcement officials came together with community leaders to brainstorm diverse approaches to the opioid crisis that are focused on preventive interventions at home, in the community, in schools, and at workplaces, as well as to learn from best practices that have been implemented in other states.
At a full-day event in Newark, New Jersey, drug enforcement officials came together with community leaders to brainstorm diverse approaches to the opioid crisis that are focused on preventive interventions at home, in the community, in schools, and at workplaces, as well as to learn from best practices that have been implemented in other states.

Hosted jointly by the Milken Institute, Horizon Blue Cross Blue Shield, and the US Drug Enforcement Administration (DEA), opening remarks at The Collaborative Community Action Meeting were presented by Valerie Nickerson, special agent in charge, DEA, New Jersey Division. Addressing the urgency to act on opioid-related deaths, Nickerson cited CDC statistics documenting 63,632 deaths in the country in 2016 from drug overdose alone, with mid-Atlantic states leading the way in death rates. “Putting that number in perspective, it’s like filling every seat in the Yankee Stadium and then some,” she said.

Essex County, which includes Newark, leads the way in drug overdose deaths in the state of New Jersey, with 271 deaths in 2016, and the first 6 months of 2017 revealed that it was on a pace to surpass the previous year’s statistics. To develop a more holistic approach beyond enforcement, the DEA announced that the City of Newark was included in the agency’s “360 strategy,” which includes comprehensive law enforcement, diversion control, and community outreach and prevention, aimed to help cities dealing with the heroin and prescription drug abuse epidemic and its associated violent crime.
Newark Mayor Ras Baraka concurred that devising a holistic approach for dealing with the opioid epidemic and considering it a public health issue was the right approach. “These kind of collaborations,” among law enforcement, healthcare providers, and public health officials, “are going to make the county and state better,” he said.

The meeting came about 8 months after the city filed a lawsuit against nearly a half a dozen opioid manufacturers with charges including false advertising and fraud. “Every aspect of our city has felt the severe ramifications of the opioid epidemic, not just the substantial financial impact, including all the services we provide to residents, including public health, public assistance, law enforcement, emergency care and services for families and children,” Baraka said when making the announcement.

The strategy has been developed by the agency with the holistic view of partnering with community leaders, healthcare providers, educators, and the corporate world in addressing the opioid crisis.

Christopher Jakim, assistant special agent in charge, DEA, New Jersey Division, provided insight on ways to act on the 360 strategy. Jakim, who has served in various capacities within the DEA in New York City, Philadelphia, New Jersey, and even Colombia, explained the 3-pronged approach of the DEA’s 360 strategy: law enforcement, community outreach, and diversion/regulatory.

Opioids and heroin constitute a significant portion of the drug epidemic in the country, Jakim said—over 42,000 deaths were attributed to opioid overdose in 2016, and the number is projected to surpass 49,000 in 2017 estimates.

In New Jersey, Jakim said that while 75% of drug users start with prescription opioids, use of fentanyl (a synthetic opioid that is 50 times more potent than heroin) has seen steady growth, with more than 800 fentanyl-related deaths in 2016 in the state, compared with about 400 in 2015. Naloxone (Narcan) was administered an average of 40 times per day in excess of 14,350 total uses in 2017, Jakim shared. He emphasized, however, that these numbers might be an underestimation, because they do not capture administrations in emergency departments or by family members and friends.

“Education is critical,” Jakim said, adding that they have had a very active program in the state through which they have addressed over 3500 doctors to engage these care providers so they can be a part of the solution. “We have a cross-collaborative approach where we bring together everyone that has touched the individual during their addiction journey to understand what may have been missed along the journey,” and identify gaps that could be filled.

The DEA expects to have a big and sustainable impact via community partnerships: involving parents and caregivers, educators in the classroom, the workplace, and grassroots community resources, he said.

A part of this process was the launch at the end of 2017 of the Newark Cares Program, a pilot program aimed at school-age children who experience trauma. Under this program, DEA works with law enforcement officials to notify school personnel when a child may have had a traumatic experience involving police. By informing the child’s school, through the Board of Education security personnel, the child’s school and/or teachers are aware of the incident and have the option of referring the child to additional support.

“We have clear objectives—bringing everyone together, looking at a collaborative approach,” Jakim said, adding that raising awareness to eliminate stigma around the disease of drug addiction is vital to the cause.

Jakim’s presentation was followed by moderated executive roundtables with specific focus and expertise around the table, with the objectives of identifying immediate actionable items, sharing recommendations, and identifying opportunities to collaborate. Focus group topics included prevention science, schools, workplace, community resources, and youth response, among others. At the end of the session, the moderators of each group shared the outcomes of their discussion with the entire group and pointed out 1 actionable item that they planned to work toward.

Speaking with The American Journal of Managed Care®, Thomas R. Graf, MD, vice president and chief medical officer of Horizon Blue Cross Blue Shield said that we have been fighting the opioid crisis for over 40 to 50 years and have had very limited success. The motivation behind this community event, he said, was “instead of each group working in its own silo and trying to find the magic bullet,” bringing the village together—pharmaceutical manufacturers, insurance providers, healthcare providers, faith-based organizations—to develop joint solutions.

From Horizon’s perspective, he said that of the 8 people dying every day from drug-related overdose, approximately one-half may be Horizon members, “so we have to take this on as a problem.” He believes this is a quality-of-life issue, not just for the person struggling with addiction but also for their family members and friends.

“We have to be a part of the team that figures out the solution, and with 130 of the best and the brightest in the room [here today], I am sure we’ll get some solid solutions,” Graf said.

Graf believes that Horizon’s partnership with 6 healthcare systems and a multispecialty group in the state of New Jersey will be the conduit for implementing care policies for their constituency. “We are already on the ground with them, looking at shared resources, persuading people to avail of care and getting them to participate in programs that will make their lives better.”

He hopes that the solutions that come out of The Collaborative Community Action Meeting will be implemented on the ground in the coming 2 to 3 months. The challenge, in his opinion, is scaling these policy solutions to the state and national levels because every community is different and the solutions need to be tailored to their specific needs.

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