Implementation science: a tool for the opioid crisis
Mentor: Dr. Brian :Piper, PhD
You are probably aware of the opioid crisis in the United States. You have heard the news talk about fentanyl overdoses on the rise or your state might have distributed Narcan in an attempt to save lives. However, you might be asking, “What is implementation science?” Turns out, you are not alone with this question.
For starters, implementation science is a science. Like biology, chemistry, or physics, implementation science follows the scientific method, meaning it develops a solution to an identified problem, tests that solution, and shares it with the scientific community for review. The “implementation” portion of the term refers to assessing parts of a system to ensure effective and efficient practices are developed and sustained. In other words, implementation science aims to make sure systems are working to the best that they can.
Implementation science started to gain traction around fifteen years ago, the same time we began picking up on the opioid crisis. Initially, the field was interested in drug development. You may have seen ads on TV for all kinds of drugs, but have you considered how much time has been invested in developing that drug before the ad appears on the screen? On average, it takes about ten years for a drug to progress from the lab to patients. Implementation scientists aimed to reduce the time for life-saving drugs to get to patients by making the development procedure more efficient.
If implementation science is so helpful, why haven’t more fields used it? Unfortunately, the field is filled with convoluted vocabulary that appears to turn off a lot of scientists. However, there are five general components to keep in mind. First, you need to have a solution with evidence to indicate it’s effective at improving patient health. Think about it, you probably don’t want to take medication that has no evidence to support its function. Next, we must consider the action arena, which consists of actors, such as nurses and doctors, government agencies like the CDC, and medical schools. We must also examine how these actors interact with each other. External factors, including laws, available resources, and social, economic, and political factors, are make or break implementation. For example, if an approach to address opioid overdoses would have to be implemented differently in Scranton as opposed to Philadelphia. There must be a measurable outcome. This part may seem straightforward but is surprisingly often forgotten. Without something to measure, we have no way to tell if our intervention is hitting its mark. Lastly, both the outcome and the entire implementation process has to be capable of being evaluated. Interventions should be evaluated for economic efficiency, redistributional equity, conformance to local values, and sustainability.
So what does this have to do with the opioid crisis? Unfortunately, many of the current efforts to curb the opioid crisis lack one or more of these components. For example, Pennsylvania distributed Narcan to its residents in December 2018; however, there is no indication of whether the drug is making its way to overdoses. It could be sitting on people’s shelves and never used. Even if it is used to treat overdoses, there is no procedure in place to identify that it came from the 2018 distribution. There are prescription monitoring programs, which prevents improper distribution via monitoring by pharmacies, prescribers, and law enforcement. However, the interaction between these actors is not properly documented and the outcome is not clear nor easy to document. Similarly, drug return programs have been implemented in some areas; however, opioid return appears to have low yields.
While implementation science is considered a separate field, I hope that as more people learn about the field, it will slowly become standard methodology in all fields of science. We can use this approach to make more effective interventions. We can use new technologies, such as artificial intelligence and machine learning, to help us evaluate these interventions and change them as necessary. I have only covered the basics of implementation science in this post; if you are interested in learning more, I suggest browsing the Implementation Science journal. I hope this knowledge serves you well and together we can deliver better care and preventative measures.
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