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.
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.
I disagree; this is a step in the wrong direction and a violation of the rights of the drug addict. The current laws allowing the forced hospitalization of suicidal people are also unjust. Every adult with the capacity to understand the consequences of their own actions, has the right to control their own life, or end it if they choose. The rest of society has no business trying to step in and override that person’s autonomy if they are only hurting themselves (and the emotional pain felt by an addict’s relatives doesn’t count, we absolutely shouldn’t prevent someone from exercising their rights just because it makes someone else sad).
I have had the unusual position of watching this situation devolve for over 2o years. the state I live in had a heroin problem in the 1900s, and instead of a fact based response they responded with lies, denial and 12 step programs, they created a generational problem. The people who were addicted to heroin in the 1990s had children, and those children, surprise: turned to heroin. It looks like wishes prayer and denial do not work, and I think Scince will back me up on that.
Alcohol is even worse, the deaths are long slow, lingering and expensive, and not much has changed about that in 25 years. Lies, and denial didn’t work for alcohol either.
Here in the US there is too much profit in denial. Plenty of people cashed in on the opioid epidemic. When the ACA came out, the Stock Peddlers were claiming that treatment centers were a good investment. There is plenty of money to be made with these unscrupulous businesses. When the people they were “treating” turned up dead, no one did much of anything, profit is profit.
Instead of a scientific fact based look at addiction all we have had is profiteering. While pretending to deal with this addiction problem, there was a profit to be made stigmatizing and attacking pain patients and physicians too. As pain patients turned to suicide from lack of treatment for their pain, nothing changed. An entire branch of expensive corporate research was directed at the denial of pain.
As long as there is a profit to be made not treating the addicted, selling alcohol in bulk, and denying people with pain basic healthcare, nothing will change. As long as the media, policy makers and self described experts are all profiteering from this misery, and Gas Lighting the public, there can be no meaningful change.
We live in a country where lies and Gas Lighting occur every day. People that turn to drugs and alcohol don’t see a future, and many have no prospects for a future. Physicians no longer serve patients, they serve corporate interests and many lie to protect the corporations. The rest have been silenced through corporate Gag Orders.
Not one of these clever self described experts on here ever pointed out how the US used to have laws and regulations concerning health marketing. The health of most Americans has declined since 1996, when the last of these laws was removed. The FDA and the CDC were supposed to protect us, instead they are now run by corporate insiders, with only one goal, to increase profits.
Even if they did hospitalize every overdoes victim, there would be nothing for them to turn to after the hospitalizations, no meaningful life, no future.
Although I absolutely agree what was said about simply handing a drug that can be easily diverted instead they need offered a treatment program long term with meds and therapy and support. I do not agree 2ith your statement that this epidemic was caused by pharmaceutical companies this is far the set from the truth those needing to pay for this epidemic is drug cartels, dealers and gangs manufacturing the actual cause of this epidemic illegal fentanyl and hetion, meth and cocaine. Prescription drugs is not the cause for this epidemic and pharmaceutical companies should not have to pay for it. Although I agree addiction is, a disease the start of addiction is not! Those of them have choices just like I as a pt with debilitating pain does. I have a choice to abuse or divert my meds or not which I have never I responsibly take and have taken my meds for over 14 years untrwted pain can also force pts yo seek relieve and cause addictive like behaviors includes turning to the streets where I believe is what happened for some who were either abruptly cut from their medications, or, tapered in effectively, or shouldn’t have been removed at all ect. Forcing these pts, to eventually turn to herion and then became addicted. All medications, have side effects we have been aware for many years that ooiid meds carry a risk if addiction doesn’t matter if a high or low, risk the risk is their, so as a pt you decide is the benefit with the risk called personal responsibility. For millions like mys3lf with chronic progressive debilitating illness causing debilitating intractable pain yes most definitely because the benefit of a, quality life and tolerable pain. Is worth it to me but less then 2 percent will get addictive if take correctly key word correctly!! But for those who already have the disease of addiction I believe in med assisted treatmrnt with long term outpatient therapy and doctor controlled but I don’t believe their should be cash Dr for this less controlled and can deni or push pts away more easily. Not offered therapy for many cash Dr they take, the money give themed and, don’t monitor them closely. All its on any med should be monitored closely . Not given by a paramedic on the street. They are not medical Dr. And shouldn’t be practicing medicine.
MAYBE ONE DAY YOU WILL GET INTO A MAJOR CAR ACCIDENT AND UNDERSTAND WHAT IT MEANS TO HAVE PAIN MEDICATION PRESCRIBED TO YOU. I REPEAT PRESCRIBED TO YOU. YOU PEOPLE HAVE BEEN BS’ed INTO BELIEVING THAT PRESCRIBED DRUGS ARE THE CULPRIT OF THE PROBLEM. WHERE DO YOU GET YOUR STATS FROM? THE PEOPLE THAT OD USE STREET DRUGS ALONG WITH PRESCRIBED DRUGS SIMULTANEOUSLY AND THEY DON’T KNOW WHEN TO STOP. THAT IS WHY THEY OD. SO STOP REACHING INTO YOUR HAT AND GETTING YOUR STATS. YOU CAN READ MY EARLIER POST TO SEE THAT I AM A CHRONIC PAIN PATIENT WITH MANY SURGERIES AND IN VERY MUCH PAIN. i AGREE ABOUT YOUR COMMENT ON ILLEGAL DRUG DEALERS. BUT IF YOU WANT TO BLAME LEGAL DRUGS FOR OD’S REMEMBER THIS. IT IS NOT THE DRUGS, IT IS THE PERSON THAT CHOOSES TO USE AND ABUSE THEM. OK DON’T LEAVE THE COMMENT BECAUSE YOU CANNOT FACE THE TRUTH.
Hang drug dealers in public, by the balls. Or the firing squad, at minimium. Society needs to mete out much harsher sentences, and hold crooks utterly responsible. All the soft laws and “understanding” of poor victimized drug dealers has to stop. Nail them !!!!
What we really need is a vaccine to prevent addiction, especially for people who are prone to addiction sue to family history. This sounds crazy, right? But crazy is how we need to think to solve this problem. You cannot stop people from wanting something they want to have. Addicts know consciously that drugs ruin their lives. Society insisting addicts make choices to stop using is unrealistic. We need to take this out of consciousness and into the body, brain and physiology.
I am not an addict, but my life was ruined by drugs due to the addiction of relatives. No one thought we could go to the moon or cure polio or smallpox, but we did.
Vaccines are viruses whose virulent properties have been removed. A virus would not be effective for preventing overdose. There are genetic markers for addiction propensity. Worthwhile study, yes indeed.
Here, here and very well said. The medicalization of addiction treatment is yet another way for Big PHARMA to continue to make big money
If medications are an “essential component” to treatment, and treatment access is severely constrained, and efforts in NJ are expanding access to buprenorphine, how are they “not a step in the right direction?” People are having to *move mountains* daily to make bupe accessible in this way, so it’s absolutely a step in a direction. What evidence supports it being the wrong one? You have data to show denying medication is better than offering it? Patients who start bupe in the ED after OD have 50-80% higher likelihood of staying in treatment post 30 days than those who don’t initiate right away. And the reason patients don’t have the opportunity to initiate when they want to — and ultimately slip through the cracks — is because people with paternalistic opinions are making policies based on impractical judgement calls.
Our son was given hundreds of Oxycodone along with Valium and Ambien after being hit by a car in Jax Fl. He had let a guy move in who needed a home and 2 weeks later our son was dead from fentanyl/heroin. We do not believe he was using that. Police called it natural causes because of what room mate said and we weren’t even called. I had to fight like hell to get a autopsy which ME refused and a toxicology was done 2 days later. I knew it was not natural. I reported this dr to FL board of health and was told I could not because I wasn’t the executor. I had to do police work cuz they said room mate had no reason to be investigated. He was a wanted fugitive in VA and was driving our deceased son’s car and stole everything and sold it. He told many stories and I placed him at the overdose. He told someone he didnt call because he was on probation. I dont know if our son could have been revived or not but I am angry AS HELL IN THE MANNER THIS WAS HANDLED. NOBODY GAVE A SHIT!! Our son and our family was treated like trash and one cop told me to quit calling and our son was fat, obese, a drug addict and more bull crap. So yeah how do we go on? The roommate stole our son’s car we feel sure and to date has not even been questioned. This is ABSOLUTELY OUTRAGEOUS and our family suffers EVERY SINGLE DAY. The dr should be in jail and the crooked atty that sent our son to him. This crap is all about greed and the only thing that will solve it is God Almighty. Lip service and more talk, talk is all we see.
Sounds alot like lock up ’em up. Blame the user. Not the prescriber. But hey, who am I? Just another one of those fighting for the basic human right to work. And be a part of a community. Rather than looked at as a disease. And being fed opioids on top of opioids as a means to fix the mess doc the dealer the created…
In the same light that interventions are ineffective, so too would your PHD sized theory of mandated mental health holds.
And MAT as means to ending the epidemic is ABSOLUTELY not the answer. Community. Inclusion. Light somewhere near the road that leads to the train station that stops at the path to better days would be a big win too. But definitely MAT. Or forced mental health psychiatric holds causing one to be given even more opioids.
A means to expunging a record for anyone with simple possession charges may assist as well. Oh. Here’s one. How about instead of letting big pharma and doc the dealer walk with a fat fine, we start locking them up for mandatory minimums? That would really shake the entire hypocrisy healthcare system up now wouldn’t it?
@OUDcollective all over the WwW | Ending Epidemics since 05TEN19
“Light somewhere near the road that leads to the train station that stops at the path to better days would be a big win too.” What does this mean, to you?
A light at the end of the tunnel…
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