As a psychiatrist in central New York, Richard Brown ’79 has seen firsthand the devastation wrought by the opioid crisis.
“One week, I had three people who had lost relatives,” said Brown, who practices through the Bassett Healthcare Network in Cooperstown.
Despite seeing the brutal evidence of the epidemic, however, Brown felt frustrated by the lack of information about what’s causing the crisis — and whether it’s getting better or worse. He reached out to Colgate’s Upstate Institute, which matches university researchers with community partners to study issues of regional importance. The institute connected Brown with geography professors Ellen Kraly and Peter Scull, who agreed to help drill down into the data to better understand what is emerging as a health crisis. They enlisted geography student fellows from the institute — Lydia Ulrich ’17 and Jonathan Santiago ’18 — to help gather and interpret temporal data and also conduct geographic systems analysis. The team also consulted with Michael Komosinski ’11 who, as an Upstate Institute fellow, conducted population data analysis at Bassett.
The group decided to take a closer look at the Internet System for Tracking Over-Prescribing (I-STOP), a 2013 New York State initiative mandating that practitioners use electronic prescriptions and check an online database before issuing one to a patient. Although the program aims to cut down on opioid abuse, some have worried that cutting down access might have the unintended consequence of increasing illegal heroin use. The researchers address the issue in a paper just published in the journal Drug and Alcohol Dependence.
“It was a clear and straight forward research question: What is the effect of I-STOP on opioid morbidity?” Kraly said. “Like a lot of research, however, the results raised more questions.” Looking at I-STOP data, they found that while the number of prescriptions for opioids decreased after the implementation, the total amount of opioids prescribed stayed the same, implying doctors were prescribing higher dosages. Even so, the number of opioid-related deaths in New York have leveled off since 2013. “That is a promising sign in light of the increasing national trend in prescription opioid morbidity,” Kraly said.
At the same time, the researchers saw a steady increase in heroin deaths starting in 2010, before the start of the I-STOP program. That suggests that other factors, such as decreasing heroin prices, might be driving it. “I-STOP didn’t cause the heroin epidemic, because clearly it had started before then,” Brown said.
Despite that conclusion, the program doesn’t seem to have succeeded in decreasing opioid deaths either. “It is necessary but not sufficient,” Brown said. “It can help identify rogue prescribers or people with aberrant behavior who go to multiple emergency rooms, but you can’t rest on that.”
Brown has pushed Bassett to adopt a multi-tiered effort to deal with the epidemic, including better communication between doctors and mental health workers, programs for safe disposal of prescription drugs, and non-opioid alternatives for managing pain. “This is the biggest epidemic of our time, and we need to be doing everything we can to address it,” he said. “I hope we can implement more effective treatment and radically lower mortality.”
The researchers’ next step is to look geographically at patterns of opioid prescriptions and deaths — examining, for example, how proximity to prescribing doctors, heroin treatment clinics, and state borders affect prescriptions and overdoses. They’ll also examine whether opioid overdoses are fewer in the area covered by Bassett’s network, as an early indication of whether their strategy is working.
While there are still more questions than answers in the opioid epidemic, the university researchers and doctors hope they can find better solutions by working together. “This is what the relationship between higher education and community organizations can be,” Kraly said. “Our students gain superb experience working shoulder to shoulder with health professionals at Bassett to build evidence-based health programs. It’s an exciting example of how Colgate can contribute in partnership with the people who are working to serve people in our communities.”