Opinion: 100,000 Americans die in a year from a disease we can treat

Combine the growing popularity of fentanyl with a pandemic that has forced people to isolate, while stripping them of direct relationships and the support systems they depend on, and it’s easy to understand the sudden increase in popularity. variable in the number of drug overdose deaths since the lockdown began.

But despite the macabre picture that trend lines paint, there is much that can be done to limit overdose mortality, said Dr. Leana Wen, CNN Medical Analyst who used to be Baltimore’s health commissioner from 2014 to 2018, said during the time the city had some highest rate of opioid overdose in the United States and is currently the chairman of the advisory board of behavioral health group, a network of outpatient opioid rehabilitation and treatment centers in the United States.
Many of program Wen has done in Baltimore – including promoting the widespread availability of naloxone, a fast-acting opioid antidote, in a pilot test strips can alert users to the presence of fentanyl in street drugs and enhance treatment opioid use disorder – she feels there is potential to limit drug overdose deaths across the country.

To tackle the opioid crisis, Wen said, we must refocus on a single mission and remind ourselves that when it comes to public health, we are all striving for the same results: save.

The following interview has been edited for length and clarity.

CNN: Experts have attributed the recent spike in drug overdose deaths to the pandemic and the rise of fentanyl. Can you explain how those two factors affect overdose mortality?

Hi beauty: Before the pandemic, we had a pandemic of opioid overdose that was mainly caused by fentanyl, many times stronger than heroin and often used to cut drugs on the street. So if someone is using their usual amount of heroin, but there’s something in it that’s many times stronger, they’re more likely to overdose and die.
Doctor's diagnosis of our broken public health system

And then the pandemic happened. Public health resources have been stretched to the limit, so those working on the opioid crisis must shift their focus to tackling the pandemic. This is necessary, but it also leaves a hole in the social safety net.

Above all, we know that addiction is a disease of isolation and that recovery depends on relationships. Many people during the pandemic have lost health insurance and the ability to receive treatment. Some may have lost other social resources such as stable housing or face food insecurity. Treatment for their addiction may not be of primary importance. Nor can we forget that addiction and mental health problems are diseases of despair, and that this pandemic has worsened the mental health of so many people. I think it’s another layering component of what was a huge problem that has lost attention and lost funding and lost people working to solve it.

CNN: How to deal with drug overdose deaths while the pandemic is still ongoing and resources are limited?

Hi beauty: We can save lives now through harm reduction. That includes making naloxone, the opioid antidote, available to as many people as possible in the community. We should also consider other classical harm reduction methods such as the widespread availability of fentanyl test strips. This is not meant to condone or encourage drug use, but if people are about to use drugs, they need to know if fentanyl is in their supply so they can reduce the risk of overdose. deadly. Then there are safe injection facilities, where Portugal and other countries proven save. They are controversial, but if our focus is to prevent mortality, we should consider all strategies that work.
We also need to make sure everyone has access to evidence-based treatment. For those treated with opioid use disorder, that means, for example, a combination of medications like buprenorphine or methadone, along with psychosocial support. The right coverage for these treatments is required – and while telemedicine should be enabled and allowed, we must also recognize that many patients need dedicated care. Ultimately, treatment for people with addiction should be viewed in the same way as treatment for people with any other medical condition.

CNN: What about possible more permanent solutions?

Hi beauty: Strengthening our public health infrastructure is critical. Covid-19 has posed many problems, including overinvestment and underappreciation of our public health system. We have seen what happened as resources are diverted from existing critical priorities to Covid-19. Of course, we need to focus on this because this is an existential emergency, but these other crises have not gone away.

CNN: What are some of the barriers to implementing the policies and initiatives you just described?

Hi beauty: For the most part, thankfully, there is bipartisan consensus that this is a matter of urgency and priority. There are partisan differences around a number of key factors – criminalizing drug use, for example. Many of us in the public health arena would say that addiction is seen as a disease rather than a crime that has passed.

Fast facts on the drug crisis

The harm reduction methods I mentioned earlier are also not widely accepted by policymakers at this time. Most people of different political ideologies would support naloxone, because it’s hard to resist the idea that if someone overdoses in front of you, you should save their life. But syringe exchange programs, often naloxone dispensing sites, are controversial. Many parts of the country still don’t allow them for fear they condone drug use, when what they’re really doing is stopping the transmission of HIV and hepatitis, and reaching people who may be able to. prone to overdose.

Also, there’s a big problem surrounding treatment. The concern here is not even so much politics as in partisan divisions, but politics as the resources we are willing to devote to this issue. There are solutions that we can exploit, but do we have the political will to devote the resources to ultimately resolving this crisis?

I understand that there are multiple funding priorities before the Biden administration and before Congress. The question is: where is addiction on their priority list?

CNN: As Baltimore’s health commissioner, you’ve been very focused on implementing specific measures such as broad access to naloxone and increasing access to treatment as part of your initiative to against the opioid crisis in the city. Do you think it is possible to launch a similar initiative on a national scale or does this require separate, local approaches?

Hi beauty: There are general guiding principles needed to address addiction in all communities. And those principles include reducing harm, increasing access to treatment, and strengthening public health infrastructure. Those are the three pillars of unity in all parts of the country. When I was the health commissioner in Baltimore, I worked closely with my colleagues in the public health field around the country, including Dr Rahul Gupta, who at the time was commissioner. healthcare in West Virginia. He mainly oversees a rural constituency and I oversee an urban one, but together we Written about how the programs we’ve implemented are similar. They are tailored to the specific constituencies we represent and the hospitals, nonprofits and community organizations we have worked with. And although there are urban versus rural approaches, the guiding principles and values ​​are the same. So I think there’s a way to scale what we know to be efficient.

CNN: Do you see this as an issue that needs to be addressed primarily at the federal, state, or local government level?

Hi beauty: It needs to be a combination. Funding must come from the federal government and must then be distributed to communities based on need. Then, communities are best positioned to understand how to use that funding for specific programs or resources in their area.

Americans are overdosed on a drug they didn't know they were taking

However, the federal government won’t give the money and say, “Do whatever you want with it.” There are very clear instructions on how to spend that money. And in this regard, the federal government has a key role to play in determining what evidence-based disposition the funds may be used for. For example, we don’t want federal money spent on rapid detox programs, which can be harmful and increase overdose rates.

At the same time, the states must do their part. Those who have not yet expanded Medicaid need to do so. We need to have the same addiction treatment policies as for all other medical illnesses.

CNN: What advice would you give to people who are facing addiction and don’t know how to seek help or what resources are available to them?

Hi beauty: If someone struggling with addiction has a primary care provider they trust and see regularly, their doctor is the best person to seek help because he or she will know them. , understand their history and will know what resources are available in their community . Besides, Substance Abuse and Mental Health Services Administration website There is a list of providers in different parts of the country and a person’s local health department can refer them to treatment options depending on the area of ​​the country they live in. In some parts of the country, there are hotlines for people to call if they are looking for help.

CNN: Are you optimistic that we will be able to turn this trend around?

Hi beauty: Public health is now at the edge of an ideological and cultural war in a way that it shouldn’t. It doesn’t help that masks and vaccinations are seen as political issues, and public health is now largely equated with Covid-19. So if Covid-19 is seen as a partisan issue, public health by default becomes partisan as well.

Fighting drug deaths is one of those issues where there’s very clear bipartisan agreement that we have a problem, unlike the Covid-19 problem. Not everyone agrees that Covid is even a crisis. Addressing the opioid crisis is one way to regain a bipartisan consensus on public health.

I’m not saying that’s why we should tackle the overdose crisis. We should tackle it because it killed more than 100,000 people in the US last year; we should deal with it because it was a pre-pandemic crisis and then it was largely forgotten.

As an added benefit, however, addressing the opioid crisis can bring us back to the heart of the issue: how public health can unite rather than divide.


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