How we can beat the opioid crisis using the tools of public health
The United States is in the midst of the deadliest drug epidemic in the country’s history. Overdoses now are the leading cause of death for Americans under the age of 50, responsible for 175 a day.
This complex problem requires multifaceted answers. As the 2017 Milwaukee County Opioid-Related Overdose Report noted, “There is no singular solution for combating this public health crisis.”
Yet there are examples of evidencebased strategies we can look to, including programs around the world that have helped combat national drug crises.
We must prioritize regulations around prescription pain medication — balancing the need to ensure adequate access to essential pain medications with minimizing incentives for over-prescribing, addiction and diversion. Evidence-based and honest drug education and prevention programs also are needed.
For those struggling with opioid and other drug use, we must offer life-saving treatment and harm-reduction programs. That means ensuring that everyone who needs it has access to low-cost, highquality treatment, including opioid substitution therapy. Prescription medications such as methadone and buprenorphine is the only treatment repeatedly shown to cut the death rate from opioid addiction by more than 50%, and it is the most effective treatment for opioid addiction, according to the World Health Organization.
For people who use heroin and who do not respond to methadone or buprenorphine, we must establish heroin-assisted treatment, in which pharmaceuticalgrade heroin is administered under the supervision of a physician in a specialized clinic. These programs have been established in several countries, including Canada, and every published evaluation has shown positive outcomes.
We also must expand access to the lifesaving opioid overdose antidote naloxone by funding community-based programs that provide it at low or no cost. We should follow the example of several European countries, which provide takehome naloxone so that family members and friends of people who inject opioids are ready to administer it to save a loved one.
We need to incorporate “drug checking,”
in which a substance is inspected to determine its contents and purity. This is a common practice in nightlife settings across Europe and Latin America. It is becoming increasingly important to use drug checking services for opioids. One of the risks of heroin use is that it has been adulterated with far more potent synthetic opioids such as fentanyl. We should move to provide free community-level access to drug checking services.
Finally, we must open supervised consumption services across the country, which provide a space for people to consume pre-obtained drugs in controlled settings, under the supervision of trained staff, and with access to sterile injecting and other equipment. There are about 100 of these operating in 66 cities around the world.
Key research findings conclude that supervised consumption reduced overdose deaths and transmission of infectious diseases, including HIV, hepatitis C and hepatitis B; provide an entry to treatment and even abstinence, and improve public order by reducing discarded syringes in public places. There has not been a single overdose fatality at an SCS facility.
Further, we should reduce the role of criminalization, which has fallen most heavily on people of color.
In the face of this crisis, let’s not repeat the mistakes of the past by rushing to criminalize people who use or sell drugs. Instead, let’s offer a compassionate, evidence-based, public health approach that places people who use drugs and their needs at the center of the solutions.
Hannah Hetzer is senior international policy manager at the New York-based Drug Policy Alliance.