Learning from 9/11: A New Approach to Fighting the Opioid Crisis
One of the major problems exposed by the tragedy on 9/11 was the inability of government agencies to reach across their silos to share critical information and to coordinate their efforts. To address that potential risk to U.S. national security, Congress voted to establish the Information Sharing Environment, the responsibility of which is to promote interoperable efforts at the local, state and federal levels. For over a decade, ISE has successfully demonstrated that sensitive information can be responsibly exchanged, privacy concerns can be effectively addressed, and organizations with histories of not communicating with each other can efficiently collaborate.
Today, the urgency for officials at every level to communicate with each other has never been greater in another realm: addressing our country’s devastating opioid/heroin epidemic, which President Trump last week declared to be a public health emergency. Even though the President didn’t provide new dollars — which he could have done by declaring the crisis to be a national emergency — Stewards of Change Institute (SOCI) would like to propose a highly cost-effective, potentially game-changing idea for taking immediate action: establish an Opioid Information Sharing Environment (O-ISE) modeled on the current, proven national security ISE.
O-ISE would serve as the coordinating entity to leverage existing state- and local-level infrastructure, knowledge and capabilities across the public safety, human services, public health and health care domains to facilitate and implement a coast-to-coast prevention initiative, as well as to improve surveillance and response. While treatment and recovery clearly are vital elements of combatting the epidemic, too little attention has been paid to date to prevention, from utilizing brain research about addiction to analyzing supply chains to inform early intervention; greater focus on stemming the crisis would shape a more holistic response, reduce long-term costs and, most importantly, save lives.
Creating O-ISE within the U.S. Department of Health and Human Services would be directly responsive to the findings in the interim report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis; that report likened the epidemic to the terrible events of Sept. 11, 2001, and recommended declaring a national emergency. Countering the opioid epidemic already had been a publicly stated top priority for DHHS.
For almost 15 years, our team at SOCI has been thinking about and working on innovative ways to utilize interoperability and information-sharing to improve health and well-being, particularly for our nation’s most vulnerable populations. (The most-recent outgrowth of our efforts is the National Interoperability Collaborative; you can learn more about it on our website.) Based on the knowledge and experience SOCI has developed, we believe the O-ISE concept could contribute significantly, strategically to dealing with the complex, cross-domain and cross-jurisdictional issues that need to be addressed to combat the most devastating health-related epidemic in modern American history.
Most importantly, given the gravity of the epidemic, O-ISE could begin quickly with a series of pilots in several states. The goals of these pilots would be to: 1). identify the key issues and relationships integral to building and operationalizing O-ISE; 2). develop a legal, policy, technical and procedural infrastructure for optimizing data interoperability and coordination across domains and jurisdictions; 3). ensure all elements of the work would be secure, respectful of privacy and other rights, replicable and achievable, and 4). prepare operational plans to scale nationally, based on the results of initial engagement.
Perhaps most pointedly, the pilots would provide a clear demonstration of how O-ISE could unite service providers across organizational and state silos to more-effectively serve high-risk populations across health, human services, housing and criminal justice systems, among others. A secondary but important benefit of creating O-ISE would be that its infrastructure, approach and learning could subsequently be applied to dealing more-effectively (in terms of impact and budget) with other health-related emergencies, from water contamination and hurricane devastation to ongoing cocaine addiction and the Zika virus. A soon-to-be-published report by the Healthcare Information Management and Systems Society (HIMSS) and the Stewards of Change Institute (SOCI) recommends utilizing the ISE model to better-address public health crises in the U.S.
It would be hard to exaggerate the scope and impact of the opioid disaster. Every day, an average of 81 people in the U.S. die from an overdose of these killer drugs. Between 2000 and 2015, the epidemic claimed over a half-million lives. The annual human toll has quadrupled since the turn of the century, while the financial cost has soared to nearly $100 billion by some estimates. There can be no doubt that the time for big, innovative responses is now; actually, it was long ago, but we are where we are.
So now, as a nation, we need two things: immediate action, because the daily impact of this emergency is so profound, and a comprehensive strategy, because that’s ultimately the only sane path out of this insane situation. By leveraging existing resources, and by following ISE’s lead in offering frameworks, infrastructure and lessons learned to be successfully integrated, the O-ISE approach offers both.