While Americans have focused on the COVID-19 pandemic, another epidemic has also been killing people across the country in unprecedented numbers: overdose deaths.
And the two crises aren’t unconnected.
Higher levels of social isolation and instability during the pandemic have added fuel to an already serious overdose crisis. As Tracey Helton, a harm reductionist in the San Francisco Bay Area, puts it, “Everything fell apart all at one time. There is the financial stress, the mental stress … the social connections that are lost. And there's fentanyl everywhere.”
A study published last month in JAMA Psychiatry found that overdose deaths seen by emergency medical services during the height of the coronavirus restrictions were more than double the rate of the year before. Early numbers just released by the Centers for Disease Control and Prevention paint a similarly chilling portrait. Overall, 2020 is on track to see about 40% more overdose deaths than in other recent years.
Addiction is not unique to the United States. Yet, as a nation, we seem to be uniquely bad at preventing overdose deaths. We have, at our fingertips, a set of commonsense practices that experts agree would help reverse the climbing rates. But up to now, we’ve lacked the political will to implement them.
One crucial step would be to eliminate barriers to obtaining medications such as methadone and buprenorphine, which are highly effective in treating addiction and preventing overdose. These drugs allow people to stop using dangerous opioids like street heroin without suffering crippling withdrawal symptoms. However, decades of draconian legislation have made access to these medications more difficult than buying heroin.
Methadone, for example, can’t simply be picked up from a pharmacy with a prescription, like medications for most chronic conditions. Instead, it often requires waiting in lengthy lines, during in-person visits to a clinic. This stigmatizing daily ritual has led many people using methadone to refer to it as “liquid handcuffs."
Buprenorphine, a similar medication, offers even better results for many people, and it can be picked up from regular pharmacies. But the federal government has put byzantine restrictions in place that limit access, and it can be difficult for patients to find doctors with the special waiver the Drug Enforcement Administration requires to prescribe buprenorphine. Even when they do, many people can’t afford to pay for doctors' visits and medication costs.
These lifesaving medications should be made cheaper and easier to obtain than street drugs. To that end, the government should consider covering the cost for patients who can’t afford them, as it has done in other public health crises such as HIV.
The United States continues to address addiction as primarily a criminal justice issue, trying to stem the overdose crisis by punishing those who use and sell drugs. But with COVID-19 running rampant in American jails and prisons, being incarcerated for possession can become a death sentence. And even without the pandemic, incarceration for drug offenses often does more harm than good. “The risk of overdose increases dramatically post release from jail and prison," notes Dr. Helena Hansen, an addiction psychiatrist at UCLA, “so we're actually killing people by locking them up.”
Apart from the astronomical cost to taxpayers, incarceration is highly destabilizing to people’s lives, and instability worsens addiction and overdose. An abundant body of research suggests that taxpayer money would be better spent on services to help patients stabilize their lives in order to leave street drugs behind. Other countries that have decriminalized drug use have seen decreases both in overdoses and overall rates of drug use.
A main driver of the current overdose crisis is fentanyl, a powerful and potentially deadly synthetic opioid that has crept into the drug supply in recent years. To use drugs contaminated with fentanyl is to play a game of Russian roulette. Imagine ordering a cocktail and not knowing whether the bartender made it with two shots or with 20, having to simply wait until you feel the effects. That is what it’s like buying drugs on the street that may, or may not, contain fentanyl. For this reason, the CDC recently recommended—for the first time — that harm reduction organizations offer the service of testing clients’ drugs for fentanyl.
One of the best ways to prevent overdoses is to simply give people who use opioids a safe supply prescribed by a doctor. Countries such as Switzerland, the United Kingdom and Canada have embraced this approach with great success during the pandemic.
Overdose prevention facilities are another promising option. Rather than using alone, people at these sites use their drugs in the presence of a health worker who can watch for signs of overdose and administer lifesaving medication if needed. Although the federal government currently bans such operations, Xavier Becerra, President-elect Joe Biden’s nominee for secretary of Health and Human Services, has publicly supported them. The data on these sites are unequivocal; there has never been a documented fatal overdose in any of the overdose prevention sites across Europe, Canada, and clandestine locations in the United States.
Although political gridlock has paralyzed much of the national response to COVID-19, a new approach to addiction has broad bipartisan public support. Across the country, in red states and blue, drug decriminalization and legalization efforts won big in the 2020 election. Oregon, for example, decriminalized all drugs. The federal government has been slow to change strategies, but even Congress is becoming more open to new approaches. On Dec. 3, the U.S. House of Representatives voted to decriminalize cannabis and expunge prior convictions, although the Senate seems unlikely to follow suit.
With record numbers of Americans dying from both COVID-19 and overdoses, action is desperately needed. The federal government must embrace commonsense measures proven to work. American lives are on the line.
Joseph Friedman is an MD/ Ph.D. student at UCLA who studies the U.S. overdose crisis. Morgan Godvin is a harm reductionist and commissioner on the Oregon Alcohol and Drug Policy Commission.
This story originally appeared in Los Angeles Times.