To continue the Schroeder Center’s behavioral health policy speaker series, Ryan Mutter, Ph.D., gave an in-person presentation titled “Responding to the Opioid Crisis.” Dr. Mutter received his BA in economics from William & Mary in 1998 and obtained his Ph.D. in public policy from the University of Maryland, Baltimore County. Throughout his career, Dr. Mutter has analyzed public policy issues through the lens of economics. He has worked at several federal agencies including the Agency for Healthcare Research and Quality (AHRQ) and the Substance Abuse and Mental Health Services Agency (SAMHSA). He currently works at the Congressional Budget Office (CBO) where he serves as a Principal Analyst. The CBO is a non-partisan, legislative branch agency that provides “analyses of budgetary and economic issues to support the Congressional budget process.”
Dr. Mutter spoke to members of the William & Mary community about the opioid health crisis, the biggest health crisis facing the nation until the start of the COVID-19 pandemic. He began the talk by addressing the question “what drew you to this particular crisis?” Dr. Mutter’s response highlighted the magnitude of the crisis, stating that over half a million people have died from opioid-related overdoses since 2000. He explained that the nature of the opioid crisis has changed over time. It began with increased use of legal, prescription opioids which then spurred waves of illegal use of heroin and fentanyl. Currently, about 2 million Americans live with an opioid use disorder, putting them at increased risk of overdose. Dr. Mutter mentioned that opioid-involved overdoses have increased dramatically during the pandemic.
Dr. Mutter talked about three types of policy responses to the opioid crisis. Supply-side policies try to limit access to “inappropriate and non-medical use of prescription opioids” and illegally manufactured opioids. Harm-reduction policies try to minimize risk to users until they are ready to seek treatment. Demand-side policies prevent people from developing use disorders and provide treatment for those who develop the disorders.
The implementation of prescription drug monitoring programs (PDMPs) is a supply-side response. PDMPs are state-run electronic databases used to track prescribing and dispensing of prescription opioids. PDMPs have been adopted by states at different times and with different characteristics. Dr. Mutter presented data from a 2017 study, which he co-authored, in Addictive Behaviors that used SAMHSA’s National Survey on Drug Use and Health (NSDUH) to look at the effect of PDMPs on non-medical use of prescription opioids, heroin use, and sources of prescription opioids for non-medical use across states. The study looked at variation in state implementation of PDMPs and its effects using a difference-in-difference framework. The study found that use of PDMPs is associated with 10 fewer days of non-medical use of prescription opioids per year. With “stronger” PDMPs, those with mandatory access and enrollment, the effect is even greater with 20 fewer days of non-medical use of prescription opioids per year. PDMPs also reduce the incidence of users going to multiple doctors in search of prescription opioids for non-medical use, also called “doctor shopping.”
Dr. Mutter then discussed a 2021 study, which he co-authored, on the relationship between recreational marijuana laws and non-medical use of prescription opioids. In this case, recreational marijuana laws are a harm-reduction policy tool. The study found that in states with recreational marijuana laws, there are “small and statistically insignificant” effects on the frequency of non-medical prescription opioid and heroin use. He mentioned that the “only statistically significant effect is the reduction in the probability” of being a frequent non-medical user of prescription opioids or a frequent heroin user.
The final part of Dr. Mutter’s presentation centered around his co-authored 2021 study of treatment, a demand-side approach, in Psychiatric Services. The study, which uses 10 years of data, sought to find factors associated with the initial choice of treatment, either pharmacotherapy, psychosocial therapy, or both, and duration of treatment. Dr. Mutter explained that less than a third of people with opioid use disorder seek treatment. The data used in this 2021 study are from private insurance and Medicare Advantage claims. The study centered around three questions: did the individual initiate treatment and if so which type; did the individual engage in treatment; and how long did the individual remain in treatment. Over 65% of patients did not initiate treatment. Of the individuals who sought treatment, 70% start with psychosocial therapy. The recommendation of the American Society of Addiction Medicine is that individuals engage in both pharmacotherapy and psychosocial therapy. Those who start in pharmacotherapy or participate in both types of therapies are more likely to stay in treatment.
Dr. Mutter finished by encouraging William & Mary students to apply for positions at CBO, which has summer opportunities available for students and full-time opportunities for graduates with data and analytics training.
Please join us on Monday, November 15, from 5-6 pm for the Schroeder Center for Health Policy’s next speakers, Jodi Kwarciany (Senior Manager, Mental Health Policy) and Stephanie Pasternak (Senior Manager, State Affairs, Government Relations, Policy & Advocacy) from the National Alliance on Mental Illness (NAMI). They will speak about “Changing Policies on 988: The Mental Health Crisis Hotline”. The FCC "adopted rules to establish 988 as the new, nationwide, easy-to-remember 3-digit phone number for Americans in crisis to connect with suicide prevention and mental health crisis counselors." Ms. Kwarciany and Ms. Pasternak will speak about 988 and its implementation. This is the last talk in the Schroeder Center for Health Policy’s speaker series on “State Policy on Mental Health and Substance Abuse.” To register and receive the Zoom link, please click here.