Last week, the NIC convened a webinar titled, "Getting Upstream of the Opioid Crisis - The Critical Role of Prevention". Its description reads as follows: "Our next Deeper Dive webinar will focus on the critical importance of “getting upstream” to more-effectively combat the most-devastating public health crisis in modern U.S. history. The presentations by our three expert panelists – along with other special guests – will include discussion of the just-published NIC Opioid Use Disorder Prevention Playbook, which examines replicable strategies being tested across the country to accomplish that goal." A recording and the compiled slide deck can presently be found on the homepage for the NIC group on opioid prevention, as can links to the recently released playbook.

The closing slide pointed out that if every one of the (then, 250+, now 300+) registered members of this group commits an average of just 5 minutes per day to sharing our insights and capabilities to address this crisis, that would be over 125 hours per week, or the work of 3+ FTEs. How can we work separately and collectively to best advance this important (and life-saving) collaborative effort?

The discussions about prevention led me to reflect on a conversation I had when I was first entering public health school. I remembered when I was a child being mesmerized by news coverage of efforts to rescue a child who fell down a well. The team that rescued her were rightfully hailed as heroes. But it occurred to me then that, had a team of public health professionals previously figured out how to cover open wells to prevent the crisis in the first place, not only would they never be hailed as heroes, but they may well be ironically (and paradoxically) criticized for the cost they caused the public to bear, when the public had not heard anything about any child falling down a well for ages. The types of prevention measures contemplated on this webinar and in the playbook truly require a culture shift to realize a transformative impact. What role can each of us play in engendering this culture shift?

A few common themes of the prevention plays came through in discussions of evidence-based strategies, and in real-world examples from California and from other state and territorial efforts. Operating at primary, secondary, and tertiary prevention levels, these efforts work to reduce the likelihood of opioid disorders in the first place, to prevent recurrences, to improve how we manage pain, to reduce the stigma, and to enhance collaboration across sectors and across stakeholder types so that we can all work together to transform these experiences for all involved. Root causes loom large. Taking "learning health system" principles I live and breathe in my daily work, how can we transform these collaborative efforts into ones that share with one another and assess progress continually so that they can continuously learn and improve?

People and their families (and caregivers) are affected by this crisis. How can we work to empower them to share what they have experienced and what they have learned to drive the types of transformation in prevention that we are envisioning?

At the same time, on a near daily basis, in this world of "big data" and corporate consolidation inside and outside of healthcare, we are hearing about the fundamental human right to privacy being violated. We are learning of large entities that treat us not as people but as sources of raw data? How can we as a broader community prevent and empower, while at the same time respecting the autonomy, privacy, and humanity of all the individuals involved? How can we ensure that our efforts impact all people and communities, especially those least well served?

The nightmare we are working to prevent is one that was created by people, systems, incentives, and social structures. We inflicted this harm upon ourselves, and ended up especially harming some of the most vulnerable in our society. As we work to eradicate this crisis through a prevention lens, how can we continue to learn from it so that we also continuously work to prevent the next crisis of this magnitude and malignancy from harming our loved ones and our neighbors?