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On Tuesday, New York City became the first city in the United States to open officially licensed injection sites: medically supervised places where addicts can find clean needles, naloxone – a drug that reverses overdoses – and options. drug treatment. During the first day of operation, officials said, trained staff canceled two overdoses.
The intervention comes amid a staggering national increase in drug-related deaths: In the 12-month period that ended in April, as the pandemic enveloped the country, more than 100,000 Americans have died of overdoses, exceeding the number of people who died from car crashes and combined firearms. This figure not only marks a record, but also an increase of almost 30% compared to the same period last year.
“If we had spoken a year ago, I would have told you deaths were skyrocketing,” Dr Andrew Kolodny, medical director of the Opioid Policy Research Collaborative at the Heller School for Social Policy and Management at the Times, told The Times. ‘Brandeis University. “But I wouldn’t have guessed it would happen to this.”
Why are so many Americans dying of overdoses, and what steps – in addition to or in place of those New York City has taken this week – could help cope with the crisis? Here is what people are saying.
“The OD crisis is in a distinctly new place”
Even before the increase last year, the United States had some of the highest drug overdose death rates among such wealthy countries, with rates more than tripling in the past two decades.
This increase was fueled largely by the opioid epidemic, which began in the 1990s when drug companies pushed to make prescription pills like OxyContin the cornerstone of pain treatment. But over the past decade, as these companies come under scrutiny for their role in the crisis, drugmakers and doctors have tightened the supply – some argue too narrowly – of prescription pills. But many of those who lost access were still addicted. The crackdown, as The Times’ Sarah Maslin Nir explains, has opened a void in the black market for cheaper, more powerful alternatives like heroin to fill.
More recently, by far the main contributor to overdose death has been fentanyl, a fast-acting synthetic opioid that can be 50 times more potent than heroin. Because fentanyl is also much cheaper to produce than traditional herbal opioids, it is increasingly being added to other street street drugs to increase their potency.
While some addicts actively seek out fentanyl, many die without knowing that another drug they had used – cocaine, for example – was related. “It’s not that fentanyl is attracting more users or creating new users,” Bryce Pardo, drug policy researcher at RAND Corporation, told The New Republic. “It’s just a very dangerous time to be a drug user and to buy street drugs.”
Many experts say the pandemic played a leading role in last year’s outbreak. Public health resources were already stretched to the limit, so people working on the opioid crisis had to turn their attention to Covid treatment, Leana Wen, former Baltimore health commissioner and medical analyst, told CNN. Many people with addictions lost their health insurance and the opportunity to get treatment, as well as the jobs that paid for their accommodation and food.
And on top of that, Wen says, âWe also can’t forget that addiction and mental health issues are illnesses of desperation, and this pandemic has made the mental health of so many worse. “
How to reduce overdoses
In recent years, Americans of all political stripes have turned their backs on the war on drugs. Polls suggest that most now view imprisoning people for illegal drug use as inappropriate punishment, but it is also ineffective: arrests and drug overdose deaths.
In contrast, treating drug addiction as a health problem rather than a crime has shown clear benefits, as the Times’ Austin Frakt wrote last year. Proponents of drug policy reform often cite Portugal as a successful case study: in 2001, the country decriminalized (but did not legalize) the use of all illicit drugs in small amounts. Overdose deaths have plummeted to the point that the country now has one of the lowest drug-related death rates in Western Europe.
But Frakt noted that the example of Portugal is often misunderstood as a story primarily about decriminalization. In truth, decriminalization was only one part of a larger strategy to encourage treatment. Portugal continues to penalize people caught possessing or using illicit drugs by referring them to regional groups of social workers, health professionals and addiction experts, who can refer people to drug treatment programs. drug addiction, impose fines or impose community service. Expanding treatment in this way, argued Frakt, “could bring the most tangible benefit to the United States.”
The $ 1.9 trillion relief bill that Congress passed in the spring included $ 1.5 billion for the prevention and treatment of substance use disorders, but critics say the response is inadequate for the scale of the crisis. Drug treatment services can be scarce and extremely expensive in the United States, even with health insurance, putting them beyond the reach of those in need. During his campaign, President Biden proposed a $ 125 billion investment to make prevention, treatment and recovery services accessible to all, but other issues, such as infrastructure, took priority.
Experts say regulatory changes are also needed to make treatment more accessible. For example, doctors still need federal approval to prescribe buprenorphine, a first-line drug for opioid use disorders that reduces overdose deaths and keeps people on treatment longer. Because it is a controlled substance, many pharmacies are also concerned that they may contravene law enforcement by dispensing it.
[âAs Overdose Deaths Soar, D.E.A.-Wary Pharmacies Shy From Dispensing Addiction Medicationâ]
For deaths to really decrease, “you have to make it easier for someone who is dependent on opioids to access treatment, especially with buprenorphine,” Kolodny said. “It must be easier to get treatment than to buy a bag of dope.”
For the first time, Congress also allocated funds this year for harm reduction measures, whose primary goal is not necessarily to help drug users achieve abstinence but to reduce their risk of dying or contracting infections such as HIV and hepatitis C.
“This is a huge signal, recognizing that not everyone who uses drugs is ready for treatment,” said Daliah Heller, director of drug use initiatives at Vital Strategies, a global public health organization. âHarm reduction programs say, ‘Okay, you use drugs. How can we help you stay safe, healthy, and alive above all else? “
There is broad support for some harm reduction proposals, such as increasing the availability of naloxone. In New Jersey, naloxone is now widely available from community agencies and pharmacists without a prescription. Officials say the distribution effort is one of the main reasons overdose deaths declined slightly in the state last year, bucking the national trend.
Other harm reduction measures, like rapid test strips that detect whether illicit drugs have been mixed with fentanyl and the type of safe injection sites that debuted in New York City this week, are more controversial. . Critics say supervised injection sites, in particular, encourage drug use, end up littering neighborhoods, or lead to an increase in crime. Yet research on real-world injection site programs – primarily in Europe, Canada, and Australia – has so far contradicted these assumptions.
Finally, policymakers should try new ways to restrict the flow of highly lethal drugs into the country, Kathleen Frydl, political historian, argues in Washington Monthly. Fentanyl, on the other hand, is mostly made in China, which ships the drug or its raw materials on cargo ships to Mexico, where it’s ended up by cartels. Much of the United States’ heroin supply also comes from Mexico and South America.
Policymakers have tended to focus on the amount of these drugs seized at the border as an indicator of success. But Frydl argues that the border ban has turned out to be a failed strategy, a strategy that simply encourages suppliers to produce more – and more potent – drugs and fosters corruption.
Instead, Frydl argues that policymakers should use trade policy to control drug trafficking:
Any trade negotiation with a source country, like Mexico or China, would include drug supply reduction targets, much like the emissions reduction targets that environmentalists argue trade deals should include.
“Before World War II, in a more multilateral era when the United States was a jostling power, American drug policy was based on taxes and tariffs, not crime and punishment.” , writes Frydl. âWe used to stop the flow of drugs through trade negotiations. It can work again.
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