Opinion: A Road Map to Combating Overdose Deaths
Misunderstandings about drug use and addiction run rampant, undermining the ability to reverse soaring overdose fatalities — a number that has quadrupled in the last decade and broke records in the last year.
I realize it’s not uncommon for public perception to be shaped by mythology, and that mistruths surround other important issues. Yet this humanitarian crisis — claiming the lives of 200 Marylanders per month and as many per day nationally — is distinguished by the massive gap between research and practice. In fact, misinformation seeps into the arenas of those in a position to make the biggest difference including policymakers and health care providers.
Enhancing public understanding is an uphill climb due to the deep-seated stigma associated with drug use. While many recognize that stigma lies at the heart of our dysfunction, it is a tough nut to crack since we criminalize drug use.
Until we admit the failure of the war on drugs, we will limp along at our own peril, straddling the worlds of public health and criminal justice.
Contributing to an ill-informed citizenry is the depiction of drug addiction offered up by mainstream media, be it in a news report or a movie. I was reminded of this source of frustration by Zachary Siegel’s piece in The New York Times Magazine, in which he laments Hollywood’s penchant for exaggeration and drama at the expense of the authenticity needed to fix our broken system.
Given the loss of life, we can hardly afford to sit back and hope the passage of time favors the facts and that enlightenment will follow. Since we can’t wait for popular culture to get over its stigma while so many people suffer, the realistic goal is the coordination of primary stakeholders, integrating their efforts in alignment with evidence.
The good news is that we have a roadmap, the product of years of research and scientific studies. The challenge is that we must follow it. Needed interventions will entail structural change and a shift in thinking, but they are not that hard.
Urging policymakers and the medical community to close the gap between science and policy, the American Medical Association 2020 report on ending the drug overdose and death epidemic spells out needed action steps. Corroborated by every major health organization in the world, and exemplified in a recent report from the National Academies of Sciences Engineering and Medicine and a 2020 study published in JAMA Network Open — is this: Treatment using buprenorphine or methadone is the most effective way to reduce overdose deaths and is crucial to curbing the epidemic in the U.S.
Long-approved by the FDA for opioid use disorder, these medications are highly effective in eliminating symptoms of withdrawal, reducing cravings, stabilizing recovery and enabling people to focus on restoring their lives — working and caring for their families.
There is no truth to the myth that taking one of these medications is akin to trading one addiction for another.
Findings reveal that medication for opioid use disorder (referred to as MOUD) is associated with mortality reductions of up to 50% compared to other forms of treatment. Data also demonstrates increased benefits from long-term maintenance on medication, with premature discontinuation associated with poor outcomes. In fact, the people who find the greatest success in overcoming addiction, often remain on medication for many years, sometimes indefinitely.
Despite irrefutable evidence on the efficacy of these medications, barriers — ranging from prescribing limits and tightly regulated clinics to arbitrary counseling requirements — limit access for 90% of people in need. And most rehabilitation programs do not offer medication and often neglect to speak about its benefits, or promote misunderstandings including unfounded warnings about its risks. Medication may not be right for everybody, but experts agree that it should be offered to all patients with opioid use disorder.
Addiction specialists stress the need for lawmakers to lift restrictions, and to end the unethical but appallingly widespread practice of denying services, such as housing, to patients taking one of these life-saving medications. Increased access would save thousands of lives as proven in countries that dropped restrictions and reduced their death toll by as much as 80%.
It is hard to understand our reluctance to take this simple step, but easy to see why the U.S. has the highest number of overdose fatalities in the world, without a close second.
Our fragmented approach and disregard for evidence compromises needed support for vulnerable people whose lives are at risk. We must do better.
Rather than blaming COVID-19 for our inability to reverse this deadly epidemic, we should turn to the AMA road map and rethink strategies. There is no doubt that COVID-19 exacerbated the challenges of addressing addiction and contributed to our death toll, but we were not on the right track before this tragedy struck, and meager declines in fatalities do not suggest a trend coming anywhere close to the dramatic increase in recent years.
In addition to low threshold access to medication, the AMA road map urges: treatment for co-occurring mental health disorders; removal of barriers to pain care for chronic pain patients; recognition of the disparities faced by communities of color; expansion of harm reduction services including overdose prevention sites; preserving families with non-punitive policies; and data collection that supports solutions.
The writer is an advocate, activist and author of “Cover My Dreams in Ink,” a memoir chronicling her son’s struggles with addiction. He died of an accidental drug overdose in April 2017. She lives in Annapolis.