It was a high profile gathering of addiction experts, clinical leaders, community advocates and policymakers all searching for answers. In the face of a growing opioid epidemic, especially in the Bronx where the meeting took place, the question is: what have we learned so far and where are we going? 

The event, “On the Front Lines of the Opioid Epidemic,” was held at Albert Einstein College of Medicine and Montefiore Health System. 

Designated as a celebration of 50 years of Einstein’s research and Montefiore’s progressive community care and outreach services, it was also a day of shared experiences and concern about one of the biggest public health crises today: 2.1 million Americans have an opioid use disorder, but only 21 percent receive treatment. The Bronx has the highest rate of overdose deaths in New York City, according to 2018 data from the NYC Department of Health. 

“More than 130 people die every day in this country because of massive opioid over-prescription and distribution. At this point, the opioid epidemic has touched everyone,” said Gordon F. Tomaselli, M.D., the Marilyn and Stanley M. Katz Dean at Einstein and Executive Vice President and Chief Academic Officer, Montefiore Medicine.

Participants all agreed that solving the problem requires a multi-pronged approach that marries scientific research, medicine and community outreach. 

We’ve Come a Long Way

Neuroscience was not recognized as a field until the 1960s. In 1974, Albert Einstein College of Medicine became one of the first medical schools in the country to create a Department of Neuroscience.  This marked the first step towards researchers at Einstein understanding the root causes of addiction.

Einstein scientists have zeroed in on nerves involved in drug-oriented behaviors, focusing on the brain’s “reward circuits” as areas that might be targets for effective medical treatments. Clinical trials on brain pathways linked to alcoholism are currently underway.

As addiction science has advanced so have innovative ways of treating addiction. Montefiore and Einstein experts shared their firsthand knowledge that the key to saving lives is getting medication to the people and communities most in need.  

They emphasized the following successes and the need for continued community partnerships.    

• Bringing buprenorphine education and treatment into primary care settings is critical. Buprenorphine is a medication that prevents opioid withdrawal and can be prescribed in many different settings. After a non-fatal overdose, buprenorphine is associated with a 37% reduction in subsequent overdose deaths. To get this lifesaving narcotic in the hands of people who need it most, nearly 50 professionals work across six Bronx clinics to care for patients and provide buprenorphine and support services. Because of this effort, more than 1,000 people have received buprenorphine since 2005.
• Creating the first partnership between an academic health system and the non-profit New York Harm Reduction Educators, known as NYHRE, has made a difference. NYHRE focuses on distribution of safe syringes and preventing overdoses, while Montefiore and Einstein provide healthcare support to drug users, including buprenorphine treatment, HCV treatment, PrEP/PEP for HIV prevention, wound care, and re-engaging patients in HIV and primary care who have been out of care. These measures have greatly reduced rates of Hepatitis C infections. 143 overdose deaths have also been avoided.
• Developing a home toolkit for people struggling with addiction has improved the standard of care.  The kit includes buprenorphine, supplementary medications, an instruction sheet and education on self-management for people beginning buprenorphine. This tactic eliminates the need for day-long, observed evaluations and is now standard of care at Montefiore clinics. The toolkits have even been incorporated into national treatment guidelines.

“We have made tremendous progress in understanding that addiction is a brain disease and that the best way to reach people in danger is at the community level, through programs like these,” said Steven Safyer, M.D., president and CEO, Montefiore Medicine. “We have the right tools, and it is time to make them work.”

What Does the Future Hold?

More research led by Montefiore and Einstein includes an initiative to review opioid prescribing across the health system and to assess patients’ preferences for reducing prescribed pain medications. This is critical because when doctors prescribe fewer pills and reduce doses, patients are four times more likely to stop seeing their providers, and often seek other sources for opioid pain medicines. Other research will focus on prescribing patterns for people leaving Montefiore hospitals after surgery. Enhancing residency education and care guidelines for opioid management are also priority areas.

Honoring the Leaders in the Field

The 50th anniversary event also paid tribute to nurses, counselors, pharmacists, secretaries and security guards who have dedicated their careers to Montefiore-Einstein’s substance abuse centers for more than 40 years.

Dr. Joyce H. Lowinson, the founding director of the Division of Substance Abuse, which has been providing preventive care, primary care, counseling, art therapy and peer support for thousands of Bronx residents, was one of the main honorees.

Click here for the list of presenters and topics: https://www.montefiore.org/agenda-7487.

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About Montefiore Health System

Montefiore Health System is one of New York’s premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 10 hospitals, including the Children’s Hospital at Montefiore, Burke Rehabilitation Hospital and more than 200 outpatient ambulatory care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information please visit www.montefiore.org. Follow us on Twitter and view us on Facebook and YouTube.

About Albert Einstein College of Medicine

Albert Einstein College of Medicine is one of the nation’s premier centers for research, medical education and clinical investigation. During the 2018-2019 academic year, Einstein is home to 711 M.D. students, 160 Ph.D. students, 107 students in the combined M.D./Ph.D. program, and 265 postdoctoral research fellows. The College of Medicine has more than 1,800 full-time faculty members located on the main campus and at its clinical affiliates. In 2018, Einstein received more than $172 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States through Montefiore and an affiliation network involving hospitals and medical centers in the Bronx, Brooklyn and on Long Island. For more information, please visit www.einsteinmed.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.