Will the Right Approach to the US Opioid Emergency Prevail?

The United States is in the midst of a devastating epidemic of opioid use affecting people of widely varying racial, gender and economic groups and status.  President Trump responded to this emergency by creating a White House Opioid Commission, headed by Governor Chris Christie of New Jersey. The Commission unequivocally recommended that the President declare a national emergency and deal with this issue as a public health crisis, committing substantial resources to drug treatment, healthcare and and other human services programs.

On August the 8, Secretary of Health & Human Services Tom Price announced that Trump would not declare a national emergency. Instead, the President regurgitated the two-pronged Regan-era “just say no” and criminalization approach to drugs. Two days later, the President reversed positions and said that he does view the opioid crisis a national emergency, and that massive resources would be put into addressing it. But what does that mean, and which course will he follow – public health emergency, or criminal justice  emergency?

The criminal justice and abstinence strategy didn’t work in the 1980s and it won’t work now. Telling young people that drugs are “No good… really bad for you” and relying on law enforcement, as the President suggests, will only lead to an increase in the number of people incarcerated rather than decrease the use of drugs. The only people who benefit from the incarceration of people who use drugs are those who have a financial stake in perpetuating private prisons, such as CoreCivic and the Geo Group – both generous contributors to the President. Mass incarceration doesn’t make communities safer and doesn’t improve individual or public health.

If the President is serious about addressing the opioid crisis and saving lives, it is time for innovation and the use of scientifically supported approaches to address our national drug crisis, not for doubling down on an approach that has continued to fail the United States and the world, costing lives, perpetuating racial and ethnic health disparities, and wasting money. Any formal declaration of an emergency must recognize that our current crisis is caused in large part by the criminalization of drug use the inability of people to access appropriate health and social services.

Project Inform and our advocacy partners remain hopeful that the Administration can correct course and embrace the recommendations of health, harm reduction, and drug policy experts that support evidence-based and compassionate strategies.  These include:

  • Preserving and increasing access to healthcare services, including substance use and mental health treatment. The Administration must cease attempts to undermine the Affordable Care Act. To adequately address our current drug crisis, we need increased expansion of Medicaid programs and the guarantee of cost-sharing reduction payments to the health insurance exchanges. Access to health coverage is critical for people who need medication-assisted treatment for opioid dependence such as buprenorphine, and who need preventive services such as hepatitis A and B vaccination, as well as screening for HIV and hepatitis C and health care services, including access to HIV and hepatitis C treatments.
  • Expanding access to the opioid overdose antidote Naloxone, particularly for people most likely to witness an overdose – friends and family, and other people who use drugs.
  • Expanding access to medication assisted treatment, like methadone and buprenorphine.
  • Supporting the creation of safe consumption services (SCS),. SCS are spaces for the safe consumption of pre-obtained drugs with unused syringes and injecting supplies (and in some cases, smoking supplies) in the presence of trained peers or staff who can intervene if overdose or other medical problems arise. SCS also provide health education and referrals to other services, as needed. SCS have been found to reduce HIV and hepatitis C transmission, prevent overdose deaths, and increase uptake of medical and social services, including drug treatment. SCS also result in less public injecting and fewer discarded syringes and other drug-related litter in the community.
  • Providing federal funding for syringe services programs to prevent HIV and viral hepatitis and connect drug users to health and social services.
  • Adequately funding the Centers for Disease Control & Prevention to respond to overdose, HIV, and viral hepatitis related to the opioid crisis.
  • Supporting trials of heroin-assisted treatment, which have been shown to improve health, social functioning, and quality of life, and reduce illicit heroin use, crime, and drug markets.
  • Supporting scientifically sound drug education for youth that is reality-based and honest.

Project Inform and partners including the Drug Policy Alliance, Harm Reduction Coalition and National Viral Hepatitis Roundtable are engaged in vigorous advocacy of a humane and productive approach to the opioid emergency. We will keep PIPeNews readers informed about developments of this important effort, and engage you when support is needed.