In the last half-century, the United States has endured three major drug epidemics. The first began in the 1970s, around the end of the Vietnam War when veterans returned home addicted to heroin. The death rate due to overdoses at that time was about 1 per 100,000 people. America’s second drug epidemic happened in the 1980 and 1990s with crack cocaine. The overdose death rate doubled to almost 2 per 100,000.

As terrible as they were, the devastation wreaked by those two epidemics pales in comparison with today’s opioid crisis. Fatal overdoses attributed to opioids alone now claim about 47,000 American lives a year — a rate of 14 per 100,000.

Meanwhile, alcohol use is linked to about 88,000 deaths in the U.S. each year — the death rate from alcohol stands at a towering 27 per 100,000.

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Addiction, in other words, is a cunning and deadly disease, and it’s killing more of us than ever before.

While there has been an unprecedented level of hand-wringing and lip service paid to better address the opioid problem, our children, parents, friends, and neighbors continue to perish. One newly instituted solution — having emergency responders “start addiction treatment” at the scene of an overdose — is an example of a Hail Mary solution.

The state of New Jersey has enabled paramedics to offer buprenorphine (Suboxone) to patients after they reverse a near-fatal overdose. In a prepared statement, Dr. Shereef Elnahal, New Jersey’s health commissioner, said that buprenorphine “is a critical medication that doesn’t just bring folks into recovery — it can also dampen the devastating effects of opioid withdrawal.”

Dr. Dan Ciccarone, who studies heroin use and the opioid epidemic, told STAT that the New Jersey effort is “a potentially brilliant idea.”

As someone who has been in the addiction treatment, recovery, and research space for nearly 30 years, I believe that providing buprenorphine at the scene of an overdose is less a “brilliant idea” than a desperate measure. It is an admission that our addiction treatment industry is under-resourced, ineffective and, in its current state, incapable of addressing the opioid epidemic or any other addiction crisis.

Having first responders provide buprenorphine after an overdose rescue is well-intentioned but woefully insufficient. It’s tantamount to having emergency responders provide Prozac to a person they just pulled from the ledge of a 20-story building and then leaving him in the building.

Every state has laws that allow for emergency holds — admission to a hospital or psychiatric facility to assess one’s mental state — when individuals are a danger to themselves or others. There would be cause for professional negligence if an emergency responder or police officer rescued an individual from a game of Russian roulette, provided him or her with a dose of a psychiatric medication, and left the scene after wishing the individual well.

Someone rescued from a potentially fatal opioid overdose needs that same professional reaction: an emergency hold. We as a society have agreed and passed laws requiring serious actions to be taken when individuals act in ways that put their own lives at risk. Treatment being unavailable or unaffordable cannot be the reason to skirt this responsibility.

The answer has less to do with enabling emergency responders to distribute a drug that can be easily diverted or misused, and more to do with acting on overdoses as we act when individuals unsuccessfully try to take their own lives. Addiction is a complex, chronic, recurring — and often fatal — disease, similar to depression.

To believe that every opioid overdose is a high gone wrong is to ignore the origins of despair associated with addiction and the data screaming out to us. If we want to stem the tide of this epidemic and prevent the next one from taking root, we need to fund addiction treatment and prevention at a level comparable to the problem.

How? When states or communities need money to build important infrastructure or large, long-term capital projects, like a sports stadium, they often turn to municipal bonds. These bonds are leveraged to spread the cost over many generations. Using municipal bonds to build the infrastructure needed to treat addiction is what’s needed in many communities across the U.S. And they can be supplemented by funds likely to come from legal settlements with pharmaceutical companies and others responsible for this epidemic.

Medications like buprenorphine are an essential component of effective addiction treatment. But they have never been, and never will be, a substitute for it. The branding of medications for addiction has shifted from medications that assist treatment to something that is treatment.

Buprenorphine, naltrexone, and methadone are not magic pills that can be given after an overdose with the expectation that the individual’s illness has been “treated.” While handing out pills seems to be the American way of solving medical problems, what’s happening in New Jersey proves we are not serious about providing the resources needed to address this epidemic.

Any “brilliant idea” that does not permanently fund prevention and treatment infrastructures at the level needed to persistently address the devastating consequences of addiction should not be consider novel or a step in the right direction.

What we need to read is a story about a state that transports survivors of opioid overdoses to an emergency addiction specialist program which offers a chronic, continuation-of-care model occurring over several months, funded by a combination of insurance and municipal bonds that are being supplemented by big pharma and others responsible for this crisis.

Until that story is published, little will change.

David A. Patterson Silver Wolf, Ph.D., is an associate professor in the George Warren Brown School of Social Work at Washington University in St. Louis, where he is a faculty scholar with Washington University’s Institute for Public Health and also serves as a faculty member for two training programs funded by the National Institutes of Drug Abuse.

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  • I feel that you are spot on with your comments and views. I feel that continuing to put a band-aid on the problem is not going to solve it. We need to stop the problem at the root source. Continuing to use the medications following an overdose is like using a garden hose to put out a forest fire. It is only going to help a little. I would be interested in your opinions on repeat offenders of Opioid overdoses.

  • These comments are painful to read so much was going through my head reading the uneducated posts by those who don’t understand the disease of addiction. I had to take a break before I decided to post a comment. I think it’s a great idea to give buperenorphine post OD where narcan has been administered, what is not being understood is the fact that the patient will be put into withdraw symptoms after given narcan. The purpose of narcan is to reverse the effects of the dope that was snorted, injected or however they got it into their system. The effects on a person’s body after narcan is administered will make them feel as if they had not used any drugs which usually means they feel ‘dope sick’ and were craving the drug which was just reversed to save their life. (Sounds crazy but that’s how an addicts brain thinks) Now 9 out of 10 times once the person comes to they are promptly discharged from the ER and scooted or thrown right out the doors. They will then go to get high again to get rid of the dope sickness they are feeling; I know lots don’t understand but this is a fact and a true look at the timeline of events. If the patient who had just over dosed and was given narcan is started on buperenorphine aka Suboxone, Subutex their feelings of withdraw and being sick will be stopped therefore they won’t be out looking for dope. Plus if the “Warm handoff” is instituted and they are admitted to a recovery center their chances of most importantly staying alive will be increased substantially. Being on Suboxone works it takes away the withdraw symptoms most addicts are afraid to go through but they do not get the euphoric feeling like they do from the opiates, do people relapse? Sure but not all and at least they had a go of it on the medication and at a treatment center with psychotherapy which by the way is mandated to all patients on Suboxone. All you need is one, just one person to say the right thing, something that connects with this person. Sometimes it’s a certain staff member or it might be another patient that talks with them, they feel a connection and then they get it, they’re ready to stop the madness. It’s better than doing nothing and just saying F-it hang the drug dealer! That does nothing to help the addict trust me another dealer is going to take their place in the blink of an eye. I don’t expect everyone to understand addiction it’s complicated but the scenario I gave you is a true depiction of what goes on. There are also lots of comments saying prescription medications haven’t been an issue in this opoid epidemic… Not all people begin with narcotic pain medication but there are a hell of a lot who do and when they no longer have access to these pills that is when they go to the streets and buy pain pills which are more difficult to acquire so heroin is the next best thing, is extremely cheaper and way more accessable, hence the opoid epidemic!!

    To Steven, when a person is suicidal and 302’ed or admitted to a psychiatric unit with a 72 hr hold generally they do Not have the proper capacity to understand the consequences of their actions. They think there is nothing worth living for they are in a totally different state of mind and the reason they are admitted is for their own safety and hopefully while they are in the hospital through therapy and possibly starting medication or changes in their medications can help them through this crisis and on a path to feeling relief from the helpless thoughts and back to a productive life. It’s absolutely not done to take away someone’s rights, if I was in that frame of mind I really hope my family, friends or physicians would realize I was a threat to myself or others and 302’ed my ass! Nobody wants to feel like that it’s when they are feeling that way there are thoughts in their head telling them it will never be better, it will always be this way, there is no reason to go on its too painful. Honestly they really need the help and are thankful for it, usually when one is in that state they do not reach out for help on their own either.
    I hope my words helped someone understand a little better about the complex and mysterious disease’s of mental health disorders and addiction, maybe not but I’ll still keep trying to help others understand so we can get rid of this horrific stigma.
    Thanks for reading have a blessed day 🙏 ❤️ 🙂

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