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We’re Approaching the Overdose Crisis All Wrong

In the shadow of the COVID-19 pandemic, the drug overdose crisis has already reached new tragic heights. Between 1999 and 2019 nearly 841,000 people died from an overdose, and in 2021 we passed a grim milestone of a lot more than 100,000 people dying from drug overdose in a 1-year period. Every one of those deaths is someone’s relative, friend, or neighbor. Why is these deaths even more devastating is that nobody should die from an overdose. We’ve years of evidence demonstrating which public health interventions keep people safe from overdose, we’ve medical interventions like naloxone to reverse the consequences of an overdose, and we’ve effective, lifesaving treatment for opioid use disorder.

These deaths talk with the decades of failure inside our policies, approaches, and treatment of and for those who use drugs.

Even though many factors are linked to the growing overdose numbers, one major driver may be the ongoing poisoning of the illicit drug supply. Increasingly, the drug supply is contaminated with unregulated fentanyl, adding a dangerous degree of unpredictability to drug use. Looking back at different waves of the existing overdose crisis, we are able to see the insufficient benefit — and outright harm — due to an outsized concentrate on supply-side interventions. In reaction to the initial wave of the existing crisis, which began in the late 1990s and early 2000s and involved rising rates of prescription opioid related deaths, the focus has been on reducing prescribing. Since 2012, opioid prescribing rates and deaths involving prescription opioids have fallen. Yet, instead of seeing a confident impact on the entire overdose crisis, we’ve seen the contrary — the death rate has increased. Individuals who use opioids have already been pushed in to the unregulated, illicit drug market as usage of prescription opioids diminished. Exactly like once you squeeze an inflated balloon using one side, another side grows.

Along with pushing people newly in to the unregulated drug market, supply-side interventions create dangerous pressures on the drug market. It has been referred to as the “iron law of prohibition.” This identifies lessons from alcohol prohibition where efforts to suppress the illicit alcohol supply created economic and logistical pressures favoring high alcohol content spirits, comparable to what we have been now seeing with pressure for stronger and compact substitutes with fentanyl analogs. In continuing the comparison with alcohol, where we’ve a regulated supply, we still be worried about alcohol use disorder and identify and address it. However, you understand the alcohol degree of the merchandise you’re consuming, whether in a bar or restaurant or purchased from the store. Now imagine instead in the event that you ordered a glass or two and couldn’t tell if it had been a 5% beer or an 80-proof liquor — you’ll haven’t any sense of how exactly to regulate it and unintentional poisonings would occur regularly. This argues for the significance of treatment; harm reduction strategies like drug checking, overdose prevention sites, and safe supply; and demand reduction interventions, which address the structural determinants of health driving chaotic drug use.

Yet, instead of buying effective and humane ways of reduce mortality, we’ve spent a hundred years criminalizing certain forms of drug use and certain populations who use drugs. And we’ve doubled down on and funded ineffective and frankly harmful approaches, without adequately supporting treatment and harm reduction interventions which can reduce overdose death. We have been now seeing the consequence of these years of failed policies and approaches.

The COVID-19 pandemic has only worsened things by increasing trauma, social isolation, lack of economic opportunity, boredom, despair, and political polarization. It has managed to get harder to gain access to certain treatments and resources that keep people safe. COVID-19 in addition has been a stark reminder of medical harms of surviving in a racist society. The impact of racism, how it intersects with and drives drug policy, and the worsening racial disparities in the overdose crisis are necessary to notice. In Massachusetts between 2019 and 2020, there is a 75% increase in opioid-related overdose deaths among Black men, and in 2021 overdose death rates among American Indian individuals were 3 x greater than among non-Hispanic white individuals. Nationally, between 2019 and 2020 the greatest increase in overdose death rates was among Black and American Indian individuals and the disparity for Black Americans was highest in areas with the best income inequality. These racial disparities are layered along with the truth that a number of these communities have been devastated by the war on drugs, which includes separated families through the kid welfare system and sent visitors to prison rather than treatment. Acknowledging and repairing those harms is vital. Making people invisible is traumatizing; whitewashing the overdose crisis does that to Black and Latino and Native communities — sending the message that their lives don’t matter

Another intersecting group that are sometimes forgotten as well as pitted against those experiencing substance use disorder are people coping with chronic pain. We’ve embarked down this supply-side strategy of cracking down on opioid prescriptions, criminal sanctions around selling and distributing drugs, and rendering it harder to gain access to drugs. It has been completely ineffective and contains not merely harmed individuals who use drugs, but additionally people coping with chronic pain for whom pain management has allowed them to operate and so are now being abandoned by their doctors.

So, if these strategies have failed, what exactly are effective pathways forward? First, knowing and employing proven ways of improve health insurance and clinical outcomes for those who have opioid use disorder is essential. The data is clear that ensuring usage of medications, namely the opioid agonists methadone and buprenorphine, will be the most reliable treatments. These ought to be made available atlanta divorce attorneys clinical and criminal legal setting and offered with, however, not contingent on, participation in other treatments or supports like psychosocial interventions or recovery supports. Second, fully embracing and funding harm reduction strategies — such as for example syringe service programs, safer smoking programs, overdose prevention sites, naloxone distribution, and much more — is vital. Harm reduction targets minimizing the negative consequences of drug use while supporting the dignity and autonomy of individuals who use drugs. A frequent misperception is that making something safer means promoting it — but does requiring seat belts promote reckless driving? These approaches shouldn’t be controversial. Lastly, we have to address people’s structural barriers and basic needs. If you are unhoused, haven’t any job, have been around in and out of prison, have already been harmed by racism, and also have no hope, why can you stop using drugs?

Healthcare systems and clinicians can perform so much to handle the overdose crisis. Buying and embracing this work isn’t only important but additionally tremendously rewarding. Substance use disorders are treatable, good prognosis conditions. Touchpoints with the medical setting offer teachable moments for engagement, support, and treatment. And there’s immeasurable joy, professional satisfaction, and privilege in partnering with patients who use drugs and the ones with substance use disorder.

Sarah Wakeman, MD, is medical director for Substance Use Disorder at Mass General Brigham and a co-employee professor of medicine at Harvard Medical School.

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