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  • Overdose deaths in the U.S. have hit new highs during the pandemic, and experts are looking for better ways to help people with opioid addiction.
  • Some U.S. cities are investigating safe injection sites, where people would be allowed to use opioids without facing arrest.
  • These sites have been used in Canada as a way to keep people using drugs safe and to help get them get in contact with services.

Drug overdose deaths hit a new high in the pandemic, with over 97,000 deaths through April 2021, according to the Centers for Disease Control and Prevention (CDC).

Recent data shows that the opioid crisis costs the United States an estimated $78.5 billion per year for just prescription opioid misuse.

Both state and federal officials are now looking at ways to reduce the cost in lives and medical resources.

Last month, Health and Human Services (HHS) Secretary Xavier Becerra announced a new overdose prevention program.

“Our new strategy focuses on people — putting the very individuals who have struggled with addiction in positions of power,” Becerra said in a statement.

“And thanks to the American Rescue Plan, we can address what so many people have seen in recent years: a rise in overdoses that can risk a person’s life — and affect their entire family.”

One approach involves giving people with addiction problems a safe, medically supervised place to use drugs — a “safe injection site.”

Taking their cue from successful, long-running safe injection site programs like Vancouver’s Insite facility, cities like New York City and San Francisco are pushing forward with plans to establish similar programs.

Recent research finds that long-term evidence from safe injection sites have an “enduring impact” on reducing drug overdoses.

However, this approach is controversial, and there are already various treatment options available to help prevent overdose deaths.

Overdose deaths related to opioid use have been a long-standing problem in the United States, but the CDC recently revealed that drug-related deaths have reached record highs.

In September 2021, the Drug Enforcement Administration (DEA) issued a public safety warning about an “alarming” increase in the sale of counterfeit pills laced with fentanyl. Fentanyl is 50 times stronger than heroin and up to 100 times stronger than morphine, according to the CDC.

“The surge in supply has led to an increase in reports of accidental overdoses across the country,” said Adnan Iqbal, MD, the medical director of psychiatry at Texas Health Arlington Memorial Hospital and Texas Health Recovery and Wellness Center.

Dr. Shereef Elnahal, president and CEO of University Hospital in Newark, New Jersey, said factors such as long-COVID, loss of loved ones to COVID-19, and the economic and psychological impact of pandemic restrictions in 2020 had a “downstream effect” on mental and behavioral health, including addiction.

“We were making progress in 2018 and first half of 2019 with the epidemic of opioid addiction, unfortunately the pandemic of COVID-19 flipped that on its head and we find ourselves behind where we were before,” he explained.

This crisis is a call to action and a reason to “double down” on resource commitments and investments to support addiction treatment and awareness, Elnahal concluded.

There are two components of the treatment of opioid addiction: safe detoxification from opioids and maintenance therapy commonly called Medication Assisted Treatment (MAT), Iqbal told Healthline.

“During the safe detoxification component, the patient is monitored and assessed commonly using a scale known as COWS or the Clinical Opiate Withdrawal Score,” explained Iqbal. “The patient is also given medication to alleviate opiate withdrawal symptoms.”

There’s a wide range of medications available to treat withdrawal symptoms. Iqbal noted that these include the drugs clonidine, lorazepam, Suboxone (a mix of naloxone and buprenorphine), and methadone.

He explained that Suboxone and methadone are used to address cravings and prevent opiate relapse. When used with relapse prevention therapy, MAT increases the likelihood of sobriety.

Elnahal recounted his experience with MAT from his time as New Jersey health commissioner.

“I authorized emergency medical services in New Jersey to use that medication [buprenorphine] to prevent withdrawal immediately after naloxone,” he said.

“And this is the reason I have EMS telling me they would sometimes give it to the same individuals three, four, five times in one night.”

Elnahal pointed out that these individuals would overdose multiple times because once revived, they had withdrawal symptoms that forced them to use opioids again.

Elnahal emphasized that treating overdoses isn’t the only option. Drugs also can help people overcome addiction. He said this is currently the “gold standard” to treat addiction.

“We used to rely on rehab, we used to rely on psychosocial services alone, to get folks out of this cycle, and it’s much less effective,” he said.

“According to the evidence, combining psychosocial counseling and treatment with medications will allow folks to wean off of their addiction over time.”

“This [addiction] is definitely a disease that there should be no stigma around,” said Elnahal. “Peer-to-peer support and psychosocial and behavioral health services paired with medication assisted treatment is the way to help people through it.”

He emphasized that the environment people live and work in, and their social environment, is a “huge determinant” of whether they relapse from sobriety.

“That’s why peer to peer support is so important, to have someone who has gone through the journey, and frankly, what recovering folks tell me is that they’re always on a journey,” said Elnahal. “Because the risk of relapse is always there.”

Elnahal said that not everybody is immediately willing to jump into treatment to get themselves out of addiction, so other measures are needed until they are.

“The concept of harm reduction allows for a safer environment for users that protects their health, while they’re going through addiction,” he explained, adding that clean needle exchanges are another option.

“As health commissioner, I was a big supporter of clean needle exchanges across the state, we had six at the time,” he said. “Unfortunately, Atlantic City shut theirs down, which was a huge loss for New Jersey and public health.”

Elnahal added that setting up enough safe needle exchanges in a jurisdiction could reduce resistance to locating safe injection sites in communities while helping prevent spread of diseases like hepatitis C and HIV.

Some cities are looking at innovative “harm reduction” measures, like medically supervised safe injection sites, to reduce overdose deaths.

Experts say that while medication can treat overdoses and blunt addiction, finding ways to get people with addiction access to treatment is crucial, and safe injection sites are one way to do this.

They also say other options, like clean needle exchanges, can help prevent disease spread while making it easier to convince communities to allow safe injection sites.