Opioid overdose should be treated like attempted suicide: with an emergency hold

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.