In 2018 alone, the US spent almost $3 billion total on the drug crisis, including grants to states and the federal government’s “main drug treatment, recovery and prevention program” but the opioid public health emergency continues to worsen.
In fact, we are an outlier among wealthy nations. There is “some evidence that [other nations] seem to be on a similar trajectory”, but as of 2014, researchers have “documented significant increases in opioid‐related mortality only in Australia and Canada”.
In part, this is due to the pharmaceutical companies overselling their prescription opioid painkillers (prior to that, our addiction/overdose rates were closer to the other rich nations), but maybe our response to the crisis has been a factor.
On the supply/demand side, we’ve focused more on cutting the supply rather than reducing the demand. Reducing access to the new opioid medications after the addiction horse had left the stables resulted in more heroin use and, worse, fentanyl use, often unwittingly.
Maybe we need to look at what other nations are doing.
France was undergoing a similar surge in heroin use and deaths in the late 1980s, early ’90s. Deaths were rising at about 10 percent per year, peaking at about 750 a year, but France has turned it around. The latest figures show overdose deaths have plateaued at 400 or less per year.
How did they do it? By treating addicts as ill, not criminal, with compassion, not contempt, and using evidence-based methods, not moralistic ones.
Harm reduction was the goal, and it worked. HIV infections also went down.
What specifically did they do?
- Needle exchanges. This is still frowned upon by many Americans because they feel it encourages drug use. This is nonsense. When drug addicts are considering intravenous drug use, the cost of the needle is not the deterrent. Nor is the risk that they might contract HIV or hepatitis. Drug addicts don’t make good decisions or cost/risk analyses. Giving them clean needles is for society’s benefit as much as theirs.
- Gave any doctor the ability to prescribe buprenorphine. In the US, while any doctor can prescribe addictive painkillers, buprenorphine – a low-dose opioid that can reduce an addict’s cravings without getting them high, allowing them to hold down jobs, work a job, and function in society – requires special permission, expensive classes, and then severely limits the number of patients to whom they can prescribe it. The apparent reason is that buprenorphine (Suboxone) does appear on the black market and – if you’re a beginner opioid user – it may get you high. Also, many people consider switching to buprenorphine (or methadone) is just trading one addiction for another.
Wrong. Addiction isn’t drug use. Addiction is continued drug use when you can see it is ruining your life and health. Buprenorphine is medication-assisted treatment (MAT) or medication maintenance treatment (MMT). It works for many people with addictions.
- Opened harm reduction centers, including mobile harm reduction centers. This is the most controversial from most Americans’ perspective. This goes beyond the safe injection sites proposed in the US and elsewhere. Take the Centre Planterose, a drop-in addiction center in Bordeaux, one of “more than 300 harm reduction centers and 480 clinics that offer opioid substitution treatment and other medical treatment to drug users anonymously and free of charge”.
Rather than having people who inject drugs (PWIDs) live and shoot up on the street, spreading infection or dying from adulterated drugs, harm reduction centers allow them to have their drugs tested for impurities and shoot up where there is medical personnel in case of overdose. In France, they also give the PWIDs a place to hang out. There’s coffee, computers, books, plus toilets, a shower, and a laundry room.
By building trust and showing them courtesy and respecting their dignity, they build trust and encourage the PWIDs to get help, including MAT, counseling, or full addiction rehab.
In the US, we don’t seem to be comfortable spending money on cures for the “unworthy”, but it benefits society and government (especially its coffers) to help the sick, even PWIDs. And it saves lives.
According to Andrew Kolodny, a psychiatrist who studies addiction at Brandeis University, “If you really want someone who’s addicted to seek treatment, you have to have it be less expensive than using heroin”.
Better access to harm reduction and rehab may be the best way.