This is an updated version of a post published by the Health Affairs Blog’s GrantWatch section on September 24.
The US Drug Enforcement Administration joined with participating local law enforcement organizations across the country on September 26, 2015, to lead the 10th annual National Prescription Drug Take-Back Day. While prescription medications play an important role in the health of millions of Americans, this event recognizes that unused drugs pose a health risk to people who take them without a prescription and pose an environmental risk when they are disposed of improperly. At this year’s event, Americans discarded more than 350 tons of unused, expired, or unwanted drugs by taking them to free and anonymous collection sites across the country.
Efforts like Take-Back Day are an important tactic in the effort to reduce prescription drug diversion and to mitigate its consequences, which are particularly alarming for one class of medications: opioid pain relievers (such as oxycodone, codeine, morphine, and methadone).
The DEA’s Take-Back Day is a great annual opportunity to lessen the availability of these potent drugs, but year-round programs are needed to address ongoing demand for this type of disposal service.
California’s Alameda County has had amazing success in finding a new way to support drug disposal. In 2012 the county board of supervisors passed an ordinance requiring drug companies to pay for collection and disposal of unused drugs, and a challenge by the pharmaceutical industry brought the case all the way up to the US Supreme Court. The county prevailed on May 26, 2015, with a favorable Supreme Court ruling.
These successes will no doubt serve as models for other counties across the United States. Local efforts like these are part of a patchwork of solutions used by communities to reduce the misuse of prescription opioid medications. And while the solutions are different in each locale, the backbone infrastructure is similar: the presence of community coalitions.
Taking lessons from other public health initiatives such as antismoking campaigns, Marin, San Diego, Los Angeles, and other California counties have each launched community coalitions that bring together leaders from across all sectors. Medical societies, public health departments, health plans, clinics, hospitals, pharmacies, law enforcement, the corrections system, community groups, addiction treatment providers, and others collaborate to work on lowering morbidity and mortality associated with the overprescribing of painkillers in a single community.
In an effort to spread this proven strategy, the California Health Care Foundation (CHCF) recently launched an initiative to support new regional opioid safety coalitions in up to 10 communities in California. The initiative will help local leaders develop steering committees and task forces to address the epidemic from multiple angles. These include safer prescribing practices, expanded access to effective addiction treatment, community approaches to overdose prevention, and coordinated communication between historical silos, such as emergency departments and primary care providers.
Coalitions will implement at least one intervention in each of the Obama administration’s three priority areas:
Disseminating safe prescribing practices
Spreading naloxone (an overdose reversal medication) in the community
Expanding access to medication-assisted addiction treatment
Selected coalitions will receive mentorship, coaching, and up to $60,000 of financial support during the 18-month grant period. Grantees will also benefit from tools like the Prescription Drug Community Action Kit, which was recently released by the National Safety Council.
Philanthropy as a Partner
These are just some of the bright spots in California, where the number of people being treated for prescription opioid addiction in publicly funded or monitored programs has nearly doubled since 2007. Over the next four years, the California Department of Public Health will receive more than $3.7 million to enhance the state’s multiagency effort to prevent deaths and injuries caused by opioid misuse. This funding from CDC will build upon the early work of the Prescription Opioid Misuse and Overdose Prevention Workgroup, which formed in 2014, and the grantmaking of philanthropic partners like CHCF.
Kelly Pfeifer is director of CHCF’s High-Value Care team, which supports policies and care models that align with patient preferences, are proven effective, and are affordable. She leads CHCF’s efforts in maternity care, end-of-life care, and the care of populations with complex behavioral health and medical conditions. Kelly was named the 2017 recipient of the Beverlee A. Myers Award by the California Department of Public Health for her work addressing the opioid epidemic. It is the agency’s highest annual award given to an individual exhibiting outstanding leadership in public health.
Prior to joining CHCF, Kelly served as chief medical officer for the San Francisco Health Plan — a managed Medicaid health plan — and medical director and family physician at Petaluma Health Center. She also served as the medical director for access for Redwood Community Health Coalition, a network of community clinics in four North Bay counties. She continues to practice family medicine. Kelly received a bachelor’s degree in English literature from Oberlin College and a medical doctorate from the Medical College of Pennsylvania. She trained in family medicine at the University of California, San Francisco, program at Sutter Santa Rosa.