JULIA MONTAG| COLUMN

A

s covered in Part 1 of this 
three-part series, a look at 
nationwide opioid overdose 

data led me to question the presence 

of an epidemic here at the University 

of Michigan, and, upon investigat-

ing, I was confounded by shockingly 

low numbers. The 2016 University of 

Michigan National College Health 

Assessment shows 98.5 percent of 

respondents answering “never” when 

asked about the frequency of their 

opiate use. Michigan is not the only 

campus that the opioid epidemic has 

skipped, Grace Bird says for Insid-

erEd. University of Wisconsin-Madi-

son recently instituted an agreement 

with pharmacy chain Walgreens to 

allow students to buy overdose-coun-

tering Narcan, even though opioid 

misuse at the school is “exceptionally 

rare,” Bird writes. Like the University 

of Michigan, the University of Tennes-

see-Knoxville has a police department 

that stocks Narcan; U-M officers have 

only needed to administer it twice, 

which is two more times than needed 

in Knoxville.

“I would agree with the general 

observation, one supported by the 

NCHA data, that the campus com-

munity has largely been spared by the 

dramatic rise in opioid use compared 

to the general population,” Robert 

Ernst, medical director of U-M Uni-

versity Health Service, says. But if 

the entire country is being hit with 

the serious crisis that is addiction to 

prescription pain relievers, what’s 

keeping the numbers so low on many 

campuses?

Colleges have avoided the rise in 

drug use, Bird claims, because the 

epidemic “discriminate[s] in terms 

of education, as it disproportionately 

affects poorer, more rural and less-

educated communities.” She explains 

the research that connects individuals 

with lower educational attainment to 

scarce, dangerous job opportunities — 

opportunities that increase the risk of 

workplace injuries and make use of an 

opioid painkiller likely.
Now, I am no doctor, but my 
extensive digging within the drug 
discussion showed me one important 
factor that college campuses have in 
common: Schools across the country 
are continuously pumping out novel, 
influential studies that work to com-
bat the crisis. An immense amount 
of research takes place at these edu-
cational hubs, including Ohio State 
University, University of Miami, 
University of Maryland — the list 
goes on — and I’d go as far as to say 

that this research is what’s suppress-

ing addiction within this subpopula-

tion. Universities are assembling vast 

resources to prevent and intervene 

upon addiction, as well as promote 

treatment and recovery. Perhaps sheer 

proximity to this information is what’s 

subduing addiction at the student level.

To corroborate this theory, I took a 

look into Michigan Medicine through 

a specific and inquisitive lens: What 

exactly is it about our university that 

keeps us from misusing? I found 

that the University of Michigan has 

assembled some brilliant minds, and 

they’re at the forefront of the crisis 

with power, intelligence and innova-

tion. Schools around the country are 

citing the University’s groundbreak-

ing studies to create the foundations 

of their programs. We have the safety 

nets and safety blankets of Wolverine 

Wellness and the CRP, just as we have 

the recovery-safe housing and medica-

tion disposal programs; we also have 

some of the country’s leading experts 

on drug misuse, and they’re working 

to revolutionize the way that the entire 

country tackles the crisis.

Among those professionals is Sean 

Esteban McCabe, an “internation-

ally recognized scholar” and former 

director of the University of Michi-

gan Substance Abuse Research Cen-

ter. McCabe is rolling out studies that 

focus on the trends of prescription 

opioid use among U.S. adolescents and 

college students by analyzing motives, 

methods of administration and symp-

toms of disorder. In his study that 

attempted to clarify when and why 

people begin to misuse drugs, McCabe 

found that “most adolescents become 

fully responsible for their own medi-

cation management for the first time 

in their lives during college and are 

presented with more opportunities for 

— and a higher expectation of — sub-

stance use.” It’s possible that his work 

has so powerfully aided in our under-

standing of why this crisis began that 

it sparked other campus programs and 

projects that mitigate concerns and 

take control of addiction.

Exhibit A: the Opioid Overdose 

Summit in 2015, hosted by the U-M 

Injury 
Prevention 
Center, 
which 

assembled folks around the com-

munity and started important con-

versations surrounding the growing 

epidemic. The University also par-

ticipated in the 2018 Opioid Abuse & 

Heroin Overdose Solutions Summit, 

where various doctors and residents 

presented on their specialties within 

the field. We have invaluable tools 

manufactured by our medical profes-

sionals and students, including the 

Michigan-made Opioid Prescribing 

Recommendations for Surgery. The 

website, of use to all patients in any 

hospital, provides new, lower recom-

mended dosages of different pain-

killers for different surgeries and 

procedures. “(W)hen patients are 

prescribed fewer pills, they consume 

fewer pills with no changes in pain 

or satisfaction scores,” the site reads. 

The suggestions were developed by 

Michigan OPEN, or the Opioid Pre-

scribing Engagement Network, which 

was established in 2016 with support 

from the Institute for Healthcare Pol-

icy and Innovation at the University 

of Michigan. Using patient-reported 

data, researchers found that previ-

ous recommended dosages swamp 

patients by meeting and oftentimes 

exceeding self-reported use, as dis-

cussed on the website.
Ernst explained to me yet another 
feature of our health system that 
fortifies proper prescribing efforts: 
changes implemented to the pre-
scribing functionality of the com-
mon electronic health record system 
shared between UHS and the aca-
demic medical center. The advan-
tages of those changes, rolled out just 
over the past few months, include a 
“single-click sign-on to the Michi-
gan Automated Prescription Sys-
tem which provides for review by 
the prescriber a detailed report of 
all previously filled controlled sub-
stance prescriptions by that patient,” 
Ernst explained. “… No prescrip-
tions for controlled substances, new 
or renewal, can be completed now 
without the provider first attesting 
to the fact that the MAPS report has 
been reviewed.” In addition to this 
detailed list, information packets 
that outline risks of overdose and 
dependence are now automatically 
provided for patients filling new pre-
scriptions. Additionally, “for acute 
pain, the duration of prescribed opi-
oids is limited to a maximum of seven 
days in order to prevent the occur-
rence of leaving unused pills,” Ernst 
said. Together, these novel features 
are paving the way for other medi-
cal centers to counter the norm and 
make new rules. 

So what is it that keeps campus-

es from misusing? I believe it’s the 

McCabes, the Injury Prevention Cen-

ters, the thought-provoking summits 

and recommendations, and the con-

sequential organizations that marshal 

vast troops of affiliates to exchange 

ideas and confront community issues 

head-on. I believe we fortunately live 

in a community where these influ-
ences are within reach. 

5
OPINION

Thursday, August 2nd, 2018
The Michigan Daily — michigandaily.com

By 
polarizing 
the 
debate over Trump’s most 
blatant 
disregard 
for 
national concern yet, his 
coterie of supporters has 
ensured any full-throated 
defense 
of 
American 
sovereignty will be met 
with substantial outcry, 
thereby redirecting GOP 
politicians 
toward 
the 
path of least of resistance. 
 
As they have repeatedly 
made 
clear, 
Republican 
lawmakers 
have 
heard 
the message and will not 
hold Trump accountable 
if 
it 
means 
upsetting 
constituents — even if 
impeachment (or at least 
moving toward it) will 
mitigate future damage 
to American international 
standing. 
In light of unending 
congressional deference to 
Trump’s ignobility, there 
seems to be little hope for 
recourse, a prospect even 
more disconcerting given 
the momentum of Russia’s 
continuing 
campaigns 
against 
American 
domestic 
security 
and 
overseas interests. Just 
as it is futile to hope that 
Trump will change his 
predispositions, it is naïve 
to call upon Republican 
members 
of 
Congress 
to 
sacrifice 
their 
own 
electoral security for some 
higher 
cause 
(perhaps 
a justification in and of 
itself for doing away with 
the 
two-party 
system 
and its many maladies). 
Republican 
lawmakers’ 
predictable 
and 
demonstrated preference 
for political expediency 
speaks to an era where 
reminiscing on the days of 
“bipartisanship” is hokey 
at 
best, 
and 
deceptive 

at 
worst, 
demanding 
a 
Congress 
capable 
of 
pushback.
As Trump’s rhetoric has 
moved beyond bombastic 
to outright terrifying, he 
has proved himself beyond 
deserving of impeachment 
and possible removal from 
office. Deliberation on the 
true nature of his historic 
missteps will not become 
a reality as long as those 
lawmakers poised to forgo 
the nonpartisan duties of 
the legislature remain in 
power. Accommodation 
of Trump and his ever-
flirtatious 
dance 
with 
outright 
treason 
can 
therefore come to a close 
only under a Congress 
headed by the Democrats, 
necessitating widespread 
electoral 
support 
for 
blue House and Senate 
candidates come this fall. 
To 
be 
clear, 
this 
is 
not a partisan call for 
a 
Democratic 
takeover 
of 
Congress 
predicated 
on liberal policy toward 
health 
care, 
abortion 
access, 
gun 
control 
or 
any 
other 
hot-button 
political issue – it is a 
straightforward 
demand 
for Congress to put its 
allegiance 
to 
America 
first, and act deliberately 
when the man elected to 
the nation’s highest office 
so clearly fails to do so. 
No longer answering to 
Trump’s steadfast base, 
maybe a new majority of 
Democratic 
legislators 
can, as Mason envisioned, 
contain 
our 
unfit 
magistrate.

What we’re doing and where we’re going

Julia Montag can be reached at 

jtmon@umich.edu

Ethan Kessler can be reached at 

ethankes@umich.edu.

CONTRIBUTE TO THE CONVERSATION

Readers are encouraged to submit letters 
to the editor and op-eds. Letters should 
be fewer than 300 words while op-eds 
should be 550 to 850 words. Send the 
writer’s full name and University affiliation to 
emmacha@umich.edu

Defaulting on leadership by Ethan Kessler continued below:

