PAF: Opioid Epidemic

By Joshua Feldman, Sophie Feldman, Hannah Marmorine, Nishant Uppal, and Eric Gastfriend.

This is the Executive Summary of the final report from a Philanthropy Advisory Fellowship project to research interventions to combat the opioid epidemic in the U.S. The full report is available here. This research was conducted on behalf of PAF client Laura and John Arnold Foundation.

Summary of Recommendations

In this report, we evaluated interventions to combat the growing opioid epidemic in the United States. We developed a methodology for evaluating interventions based on 3 key criteria: evidence, cost-effectiveness, and scalability. We also created a scoring rubric to simplify our conclusions on the strength of the interventions in each of these 3 areas. We looked at interventions in 5 broad problem areas: pain treatment, opioid supply, addiction treatment, access/referral to treatment, and harm reduction. There are many more interventions and problem areas that deserve consideration but fell outside the scope of our project (e.g. criminal justice, drug policy). Our research was based on expert interviews, reading reports and studies, and our own Fermi estimations when data was unavailable. In particular, we relied heavily on Phillips 2017 and Tick 2017 for assessments of the quality of evidence, and on the Washington State Institute for Public Policy for cost-effectiveness estimates. The scope of this report is to evaluate a set of interventions for addressing the opioid epidemic, but does not consider particular organizations implementing these interventions, or the best ways that philanthropy could promote these interventions.

Our recommendations are:

• Invest more effort in continuing this line of high-level, strategic philanthropy resource to better determine where resources can be best allocated for the crisis.

  • Develop a formal model of the opioid ecosystem

  • Fund the Washington Institute for Public Policy to publish more detailed cost-benefit analyses

  • Deepen and broaden the intervention search beyond what this report has started

• Pain Treatment: Recommended Interventions

  • Chiropractic manipulation for chronic back pain

  • Acupuncture for chronic back pain

  • Exercise therapy for chronic back pain

• Opioid Supply: Recommended Interventions

  • Opioids safe prescribing training during medical school

• Addiction Treatment: Recommended Interventions

  • Computerized CBT

  • Contingency Management

• Access/Referral to Treatment: Recommended Interventions

  • Inpatient Addiction Consult Teams

  • ER post-overdose referral to care

  • Level-of-Care Treatment Matching

• Harm Reduction: Recommended Interventions

  • Drug Checking

• Prevention/Education: Recommended Interventions

  • Preventure

The full report is available here. Please contact huea.studentgroup@gmail.com if you would like more detailed information contained in our research spreadsheet.