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It has been said that the opposite of addiction is connection. Covid-19, however, has frayed societal connections. For Americans with substance use disorder, connections that were already fragile are at a serious breaking point.

The Covid-19 pandemic has resulted in an increased risk of using drugs alone, changes to the drug supply, and initiation or increased use of substances by individuals. Right now, the U.S. is facing unprecedented levels of overdose deaths, with an estimated more than 90,000 overdose deaths from October 2019 through September 2020. Driving this is the increasing availability and use — both knowingly and unknowingly — of highly potent, illicitly manufactured fentanyl and fentanyl analogues.

Faced with these facts, policymakers are asking the urgent question: How do we better protect those at risk for overdose?

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Over the long term, the U.S. must take the necessary steps to build an addiction infrastructure that can prevent addiction, link people to and provide quality treatment for people with substance use disorders, and support long-term recovery.

In the short term, the U.S. needs to provide interventions at every opportunity to reduce overdose risk, meet the needs of people in treatment, and care for people who are using substances as well as those with substance use disorders who are not in treatment or in recovery. We need to bend the curve and prevent people from dying from overdoses.

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This means scaling up syringe services programs (sometimes referred to as syringe exchange or needle exchange programs) to provide a connection to services and care. Such programs should include access to naloxone, a safe and fast-acting drug that reverses opioid overdoses and has saved thousands of lives nationwide. Administering naloxone to someone who has overdosed — or providing it to someone at risk of overdose or their families or friends — builds trust and provides support for people in need. Our country can also improve connections to care, particularly after an overdose, in settings such as emergency departments.

Making it easier to access fentanyl test strips is another essential step to save lives, foster engagement, and build trust with underserved and at-risk populations.

Fentanyl test strips can be used to detect fentanyl and, in some cases, fentanyl analogues, which are commonly found in the drug supply — alone and mixed with other illicit drugs such as heroin, cocaine, and methamphetamine. They are the leading driver of overdose deaths. Individuals using a drug — as well as those responding to an overdose — may have no idea that a powerful synthetic opioid is present.

Fentanyl test strips not only have the potential to reduce overdoses, but the process of obtaining them can bring individuals with substance use disorders in contact with a community organization or other harm reduction supports for the first time and can lead to reduced risk for drug-related harms and improved health outcomes.

However, federal funding for two large initiatives focused on the opioid crisis could not be used to purchase fentanyl test strips — until now.

In April, the Biden-Harris administration removed those restrictions to allow federal grantees such as state and local health departments, state substance abuse agencies, and community-based organizations and health systems receiving federal funding the flexibility to use grant dollars for this inexpensive engagement tool.

These interventions — these connections — are one way to curb rising overdose deaths. Building these connections requires funding, which is why President Biden included nearly $4 billion for behavioral and mental health services in the American Rescue Plan. Half of these funds will be spent on addiction prevention, treatment, and recovery services. Yet even with this increase in federal investment, a yawning treatment gap persists. Only 18% of people with a past-year opioid use disorder reported receiving medication-based treatment, the standard of care, in the past year.

Fentanyl test strips alone will not bridge the treatment gap or turn the tide of overdoses overnight. But they are an important part of the all-of-the-above approach that must be employed to bend the curve of overdose deaths.

Making it a priority to give people with substance use disorders every opportunity to connect with services and to be more aware of the substances they are using will slowly build bridges that meet the needs of people with addiction and ultimately save lives.

Regina LaBelle is acting director of the Office of National Drug Control Policy. Tom Coderre is the acting assistant secretary for mental health and substance use in the federal Substance Abuse and Mental Health Services Administration. Rochelle P. Walensky is the director of the Centers for Disease Control and Prevention.

  • You MUST put safeties in place because of all of the unscrupulous “treatment” personnel. This money can NOT be squandered on “treatment facilities” services run by the former “pill mill” doctors… THAT’S where those doctors ended up, if they aren’t incarcerated. The proliferation of “cash only” facilities are manned by those greedy former pill mill drs. n many cases.
    There is also a need to put much more of this funding toward safe injection sites, manned by professionals who can explain and demonstrate the use of the illicit fentanyl test strips, provide naloxone – sometimes multiple doses at one time – to any individuals who are trending toward an overdose, and provide education and referral services to those who want to get clean. But you must remember that MANY of those individuals are NOT interested in or going to get clean just because the option is there. These people are masking deep symptoms by using heroin, illicitly manufactured fentanyl, cocaine, methamphetamine, and all of the other illicit drugs that IMF is added to; they KNOW that if/when they get clean, those deep-rooted emotional symptoms will STILL be there. And that’s what keeps them using, even in the face of consequences.
    I would truly suggest that you initiate a research study using drug abusers as participants, gleaned from these harm reduction centers, and REALLY listen to them – HEAR their words, then you will know better how this IMF epidemic can be mitigated. There ARE solutions out there, if you are brave enough to buck the current culture! And decriminalization of ALL illicit drugs will make them so much less attractive to newly initiated users. Many, many countries, most recently Central and South American countries, have taken Portugal’s lead and moved to decriminalize illicit drugs. These countries are now finding that this leads to great success and reductions in drug overdoses (Portugal had SEVEN illicit drug overdoses last year.. that’s ALL! Now wouldn’t the usa like to be able to brag about stats like that?) YOU are in the position necessary to effect REAL change; then again, you could chicken out and keep the status quo going. It’s really up to you, ONDCP, SAMHSA, AND cdc. And cdc, you need to take a REALLY close look at your behavior of the past 5 years, skewing statistics, leading in the hoodwinking of the general public, CAUSING suicides thanks to your kowtowing to PROP, and many other topics. Just because you’re “handling” the COVID-19 stuff, which actually IS within your jurisdiction, you have lost the respect of SOOOOO many individuals who are “on to” your shenanigans (a nicer word than LIES AND MISCONCEPTIONS).

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