I’m a paramedic, chemist, and drug researcher, and this what I want you to know about the worsening overdose crisis.
We are deep into a deadly epidemic.
Hundreds of thousands of lives have been lost to an oft-misunderstood enemy, and public health messaging is frequently at odds with policymakers, bureaucrats, and the anxieties of the public — resulting in inconsistent and slow progress towards a solution.
We are deep into an epidemic of overdose deaths caused by a poisoned illegal drug supply.
COVID-19 has, very understandably, dominated headlines and preoccupied our leadership in recent months, but that doesn’t erase the critical importance of addressing the overdose epidemic.
In the United States, 2020 was the single worst year on record for overdose deaths, with
This represents a nearly 30 percent leap in deaths from 2019. And, thanks to
How did we get here? And what can we do now? Let me explain.
When you hear the phrases “overdose epidemic” or “opioid crisis,” you might think of prescription opioids. There’s been considerable attention and headline space given to the Sackler family, Purdue Pharma, and the problematic prescribing of powerful and long acting opioids, like OxyContin.
There’s good reason for the coverage. Purdue is accused of inappropriately marketing OxyContin, pushing for increased prescribing even when not indicated, telling prescribers that OxyContin lacked addiction potential when their own data indicated otherwise, and other ethics and fraud charges.
In response, three major initiatives came about:
- State-operation prescription drug monitoring programs (PDMPs) were introduced to spot non-clinical use of opioids and other medications with misuse potential.
- Public health campaigns aimed at prescribers focused on slowing down the prescribing and even deprescribing for patients with chronic pain who were functioning well on opioids. Incidentally, the latter would eventually become another concerning and under-addressed consequence of the overdose crisis.
- Tamper-resistant opioid tablets were rolled out to prevent the misuse of opioids by making them impossible to crush and snort or inject.
These initiatives started to shift the tides a bit,
Unfortunately, any celebration was cut short by another finding in the data: Overdose deaths attributed to heroin and (often illicitly manufactured) synthetic opioids had
Synthetic opioids, like fentanyl, began appearing more and more in the illegal drug supply. Today, these synthetic opioids, which are often illegally manufactured, have become almost commonplace.
Synthetic opioids are exceptionally potent, hitting hard and fast. This potency can also be extremely useful in a clinical setting.
But it can have devastating consequences for people who think they’re purchasing heroin or another drug and get something contaminated with synthetic opioids. For what it’s worth, drug sellers often don’t know their product is contaminated, either. Later, when the person consumes the drug, the synthetic opioid’s swift onset comes unexpectedly, causing an overdose.
In a country where the sale, possession, and use of drugs are heavily prohibited, many consumers are pushed into hiding to use drugs of unknown potency.
The result? People are experiencing overdoses in seclusion, dying alone in restrooms and cars.
The onset of COVID-19 in early 2020 meant abrupt and significant changes to daily life for everyone, including people who use drugs.
Physical distancing guidelines, financial insecurity, and global supply chain disruptions forced many consumers to buy from unfamiliar sellers, use drugs alone more often, and experience delayed access to substance use disorder treatment, mental health counseling, and outreach resources from harm reduction groups.
Each of these factors can increase someone’s risk of overdose or returning to drug use.
COVID-19 has, in so many ways, upended people’s lives and taken so much from them. As such, it may seem like an obvious source of blame for the sharp increase in overdose deaths in 2020, but it’s important not to fall into that trap.
There was already an
increasein overdose deaths before the pandemic.
But the real culprits — stigma, the abandonment of our neighbors in need, and the rejection of evidence-based best practices in public policy and health in favor of continued (and often increased) prohibition of drugs — are every bit as insidious as the coronavirus.
All of these factors — overprescribing, a poisoned drug supply, the pandemic — exist against a backdrop of the war on drugs. This sweeping program, launched by President Nixon, to stomp drugs from American life with hawkish strategies of prohibition, criminal sentencing, and international relations turns 50 this year.
In certain ways, the policies it helped create meant well. Some attempted to prevent drug use in children, for example. Others tried to directly eliminate the supply of drugs.
And things don’t seem to be getting any better. As prohibition against fentanyl increases, new synthetic drugs are appearing in the illegal drug supply, popping up incessantly like a game of whack-a-mole.
The enormous investment of money, time, effort, and lives into the war on drugs seems to be in vain. But this doesn’t mean there’s no point in trying to prevent drug use. Doing so just looks different than many imagined it would.
A community with low levels of drug use isn’t one that’s heavily policed, its members threatened with staggering sentences for possessing drugs.
Communities with low levels of drug use are healthy, happy ones that invest in their people and infrastructure. They support families and invest in education and job training. They make healthcare, including mental healthcare, easy to access.
In short, they’re communities that care for each other, and this is where drug use prevention dovetails into larger-scale initiatives.
Supporting childcare, public education, and parents pays off. Investing in healthcare and healthcare accessibility pays off.
The overdose crisis didn’t happen overnight, and undoing it is going to take years. But the work and time this demands is not only worth it, but it’s also necessary. We must stop the bleeding and start taking action.
I believe in my community and neighbors, and I’d guess you do as well. I believe that the health and well-being of our communities is all of our responsibility. I believe that my neighbors experiencing homelessness, who are more likely to use drugs, are still my neighbors and very much part of my community.
Battling back against the overdose epidemic requires everyone, including you, to pitch in. Here are some achievable steps you can take to start turning the tide.
Support harm reduction programming in your community
Syringe access programs are relatively inexpensive and result in huge payoffs. They provide clean syringes to people who inject drugs, reducing or even eliminating the reuse and sharing of syringes.
These programs do all of this
But these programs are usually poorly understood and feared. As a result, they often face an uphill battle in securing approval from local communities.
You can help by reaching out to your local harm reduction group, asking them how you can help, and talking with your family, friends, and neighbors about how these programs can help the community.
Push back against stigma
Chances are, you know more drug users than you think. They’re your neighbors, family members, coworkers, and other “regulars” in your day-to-day life.
How would you feel if someone used language that dismissed them based on their health, lifestyle, or other factors?
Speaking up when someone makes a stigmatizing comment or joke about people use drugs is simple, but it’s not always easy.
For example, the next time you hear someone call another a “junkie,” try responding with something like, “I know you probably didn’t mean it in a harmful way, but consider saying ‘people who use drugs’ instead. It’s a small thing that lets people who use drugs know that they’re still people in our eyes.”
Advocate for Medicaid expansion
While most states have already done this, 12 still have not. Medicaid expansions offer significantly expanded health insurance coverage to low-income individuals.
This allows for the treatment of substance use disorders, as well as mental health conditions, chronic pain, and other issues that tend to co-occur with substance use disorders.
What Medicaid expansion will look like, and how it might be voted upon, look different depending on where you live. Learn more about next steps and what you can do in the meantime here.
Carry naloxone and encourage others to do so
Carrying naloxone (and knowing how to use it) is one of the easiest and most direct ways to get involved.
Naloxone is a widely available medication that can reverse an opioid overdose, potentially saving a life. It’s very safe, and it can’t cause an overdose. You never know when you might come across someone experiencing an overdose, but you can easily prepare yourself to be a first-responder in that scenario.
Visit naloxoneforall.org to find free or low-cost naloxone near you, and watch an instructional video on how to use it.
You can also find in-person instructions on using naloxone, or visit your local pharmacy and ask the pharmacist to show you how to use it — they’ll likely be very eager to help.
Show up for your community
Combatting something as large and unwieldy as a national epidemic of drug overdoses can feel overwhelming. As someone who works in this area, I know the feeling well. But I’ve found that taking action through small, achievable steps makes a huge difference, especially when everyone does it.
A common truism in harm reduction is that the opposite of addiction isn’t abstinence, but connection.
Focus on reaching out to neighbors and supporting your community, even if it doesn’t directly involve people who use drugs.
For example, visit a family in your neighborhood to offer help with babysitting. Check in with your older neighbor to see if they need help with errands or a listening ear. Tutor students or coach an extracurricular activity at a nearby school. Find a place to volunteer with your family, and make community care a tradition you pass on to your kids and grandkids.
As the climate of the overdose crisis changes, so will the necessary steps for pushing back. We’re headed into the fourth wave of the overdose crisis, marked by a significant uptick in the use of stimulants, like methamphetamine and cocaine.
As these drugs begin to dominate, the resulting health and safety needs associated with drug use will shift.
Staying connected with your local harm reduction organization, even by simply signing up for their newsletter or following their social media accounts, will help you stay aware of what new priorities look like for people who use drugs in your community.
Above all, support and love one another. When we all do this, we are stronger, healthier, and happier. We live longer and are more insulated against emergencies and natural disasters. And so-called “diseases of despair,” like substance use disorders and suicide, are battled back.
Start with something simple and consistent, and see how incredibly far we can go together.
Claire Zagorski earned a bachelor’s degree at the University of Texas at Austin and a master’s degree at the University of North Texas Health Science Center. She has practiced clinically as a paramedic in multiple treatment settings, including as a member of the Austin Harm Reduction Coalition. She founded Longhorn Stop the Bleed and is committed to supporting healthcare professionals who seek to integrate harm reduction principles in their practice.