By Angela Turnbow for BioLawToday.org
The Center for Law and the Biomedical Sciences, the Honors College, and the Program in Medical Ethics and Humanities at the University of Utah hosted a “Conversational Summit” on the Opioid Crisis in Utah, Monday, April 23, 2018. The event, organized by professors Leslie Francis, Margaret Battin and Teneille Brown, was remarkably successful in bringing together many different stakeholders. The purpose of the summit was threefold: 1) to develop coalitions between health care providers, public health agencies and the criminal justice community; 2) to identify barriers to effective treatment of pain, addiction, and their aftermaths and 3) to begin to explore strategies that address these barriers.
The event began with a provocative and energizing keynote by Dr. Mark Tyndall, director of the British Columbia Centre for Disease Control and professor at the School of Population and Public Health at the University of British Columbia. His presentation, titled “The Critical Role of Harm Reduction in the Opioid Overdose Crisis,” explored strategies for reducing health risks and preventing overdose fatalities—which in the US now claim more lives than suicide, homicide, and automobile accidents combined. Some of these strategies are controversial in the US, from needle exchanges to safe injection sites to measures for assuring that drugs like heroin are not adulterated with the far more dangerous drugs fentanyl and carfentanil. Dr. Tyndall also discussed background theoretical issues, for instance, whether addiction should be addressed as a potentially criminal activity, as an illness, or as an ongoing practice which, if controlled, need not always be completely eliminated. He described the development of overdose prevention centres in British Columbia and elsewhere. He also responded to questions, for instance, about self-medication for pain and whether situations that encourage or enforce abstinence (e.g. prisons, drug courts, and private drug treatment programs) actually increase the risk of overdose fatalities, since the no-longer-drug-tolerant person who relapses and returns to their previous use is at much greater risk of death. In all of the discussions, the question for Dr. Tyndall is how to save lives with the least social disruption and the most effective strategies. Dr. Tyndall recently gave a TEDMED talk on his research, which can be found here: https://www.tedmed.com/talks/show?id=688239.
The afternoon was then divided into three different sessions to address the specific issues faced with the opioid crisis. Panelists each gave five-minute “microburst” presentations on their role in combatting the crisis in Utah and the practical and legal barriers that make it harder for them to do their jobs. These panelists included emergency, cancer, addiction and pain physicians, pediatricians, nurses, addiction recovery therapists, child welfare advocates, pharmacists, defense attorneys, prosecutors, drug court representatives, poison control experts, data specialists, public health officials, harm reduction advocates, and many others. The general aim of these very brief presentations was to allow as many participants as possible let the widest range of others working on the opioid crisis know what, in these speakers’ judgment, is most likely to be misunderstood or overlooked, and most important for them to know.
The first session, moderated by Peggy Battin, was titled “Starting on the Path Toward Opioid Use.” It discussed the different points of entry for individuals who become addicted to substances and the ways physicians can ethically treat pain. Session Two, “Identifying Warning Signs of Trouble, Addressing Trouble, and Mitigating Harm,” was moderated by Leslie Francis. Panelists discussed how to identify addiction, the role of public health, and the resources available for those needing treatment. Teneille Brown moderated the final session, “Dealing with the Aftermath: Remedies, Punishment, and Treatment in Policy and Law,” to consider questions on how to respond to addiction to opioids, such as the role of drug courts, access to substance abuse services in the criminal justice system, problems with re-entry, and elected leaders’ involvement in addressing the opioid crisis.
Overall, the summit was a promising, indeed extraordinary first step toward establishing a critical dialogue and forging new relationships between individuals and organizations, and opened up possibilities for collaboration. It certainly gave everyone in attendance something new to think about. Because of the complexity of the opioid crisis and the many groups involved in working to reduce it, smaller groups will be meeting to address specific legal, policy, and education action items. This is just the beginning of what we hope will yield many productive collaborations. Please let us know if you are interested in participating.
Further to this goal, we also look forward to the Utah Law Review annual symposium, this year titled “The Opioid Crisis: Paths Forward to Mitigate Regulatory Failure,” which will further this discussion from the legal point of view.
Many thanks to the organizers, staff, and cosponsors for planning the event, and to the many dedicated individuals who made it such a success.
Angela Turnbow is an Academic Coordinator at the S.J. Quinney College of Law. She provides support for the Utah Law Review, the Center for Law and Biomedical Sciences, and the Environmental Dispute Resolution Program.