We didn’t lose the War on Drugs, we surrendered
Addiction and overdose deaths have grown exponentially for decades. More money to fight back is needed, yes, but so are new ideas, explains Pitt public health dean
As an epidemiologist, I’m exasperated. Facing a raging epidemic — of drug addiction and overdose deaths — we dither. Even an ounce of prevention would look good at this point.
This epidemic of drug overdoses has been growing at an exponential rate for at least four decades. Counts of overdose deaths in the United States have increased relentlessly, doubling every eight years.
Deaths are mounting at an accelerating pace: two-fold, then four-, eight, 16- and 32-fold over the past 40 years. But it is the preternatural predictability of the epidemic growth pattern that is most worrisome.
As drugs come and go — cocaine, prescription drugs, heroin, fentanyl — the curve goes up. As law enforcement and treatments change, the curve goes up. As the epidemic demographics evolve from urban to rural, black to white, male to female, the curve goes up. There is no end in sight to this inexorable upward trajectory. We are on track for another 300,000 overdose deaths in the next five years. The growth curve of overdose deaths here in Allegheny County is also inexorable and exponential.
Across the nation, the public is keenly aware of the toll — and the pathos — of the epidemic: In Ohio, parents were found passed out in the front seat of their car with toddlers crying in the back seat; in Pennsylvania, a young couple overdosed, leaving their abandoned baby to starve to death; in Virginia, a prom princess was found dead.
Year after year, the same frontpage story reports that this year (again) death counts were higher than last year. By now, everyone seems to know someone who OD’d. Governors in five states have taken the extraordinary step to declare the epidemic a public emergency.
The financial consequences are staggering. According to an analysis by the Centers for Disease Control and Prevention, in 2013 the opioid epidemic in the United States cost $78 billion, including lost productivity, crime and law enforcement, prevention and treatment, and other costs. One quarter of these costs were born by the public sector.
No up-to-date estimates are available for 2017, but if the growth of the financial burden has paralleled the growth of the death burden, then the costs now probably exceed $100 billion per year, with a plausible forecast of another half-trillion dollars over the next five years.
Based on the federal funding response, though, you would never know we are in a crisis. Let’s follow the money.
Three key federal agencies are responsible for control of drug addiction: the National Institute of Drug Abuse of the National Institutes of Health, the Substance Abuse and Mental Health Agency within the Department of Health and Human Services and the Drug Enforcement