Accidental drug overdose is currently the leading cause of death in the United States for those under 50. Drug overdose deaths now exceed those attributable to firearms, car accidents, homicides, or HIV/AIDS. More Americans died from a drug overdose in 2017 alone than died in the entire Vietnam War.
Most of these deaths are preventable, but the "tough on crime" rhetoric of the decades-long drug war and the stigma associated with drug use have blocked the widespread adoption of life-saving overdose prevention and treatment policies.
The Drug Policy Alliance (DPA) is leading the national effort to reduce drug overdose deaths by promoting sensible, evidence-based solutions at the state and federal level.
The causes underlying the overdose crisis are complicated. While it is true that pharmaceutical companies and doctors played a significant role in the vast increase in the number of opioid medications prescribed, the singular focus on the supply of opioids has overshadowed analysis of the demand for drugs, including opioids — that is, the reasons why some people use drugs problematically to begin with.
The people to whom opioid painkillers were prescribed, for instance, were rarely the ones who misused them—rather, the opioid oversupply entered the illicit market both formally (sold on the streets) and informally (borrowed or stolen from medicine cabinets).
Factors such as poverty, lack of economic opportunity, and limited access to a social safety net meant that there was ready demand for those opioids, particularly in deindustrialized states like West Virginia or Ohio. People used and are using opioids, and, increasingly, other drugs like cocaine and methamphetamine, to escape their social disadvantage and hopelessness. And, once people become addicted, we have little infrastructure in place to ensure they receive the education, care, and treatment they need to prevent fatal overdoses.
Our solutions to this crisis must be as varied as the complex array of intertwining factors causing it—a multifaceted and long-term approach is required.
What You Need to Know About Fentanyl
Many states are reporting sharp increases in fentanyl-related overdose deaths. Fentanyl overdoses occur in seconds to minutes, often with the needle still inserted. Most users do not appear to be seeking fentanyl and are not aware that their illicit drugs may contain fentanyl. The heroin (particularly white powder heroin), methamphetamine, and cocaine supply is all at risk for fentanyl adulteration. There have also been cases of counterfeit Xanax and Oxycodone tablets that contain fentanyl.
Most of the fentanyl on the black market is not from the medical supply; it is produced illegally. Though some fentanyl enters U.S. markets directly via the dark web, most fentanyl is being added to the drug supply before it enters the U.S., so domestic sellers may not know their drug products are contaminated with fentanyl. There are public health and harm reduction responses to fentanyl that are effective in reducing overdose deaths.
Fentanyl is increasingly the "new norm" in man parts of the country. Increasing penalties for fentanyl, therefore, will simply end up increasing penalties for heroin and contribute to more incarceration.
Overdoses and other drug-related medical emergencies are far more common than most people think – but they do not have to be lethal. Learn the signs of what an overdose looks like for some commonly used drugs (alcohol, MDMA, cocaine and other stimulants, and heroin/opioids) and what actions you can take to help save someone’s life.
Denise Cullen, executive director of GRASP (Grief Recovery After a Substance Passing) and Broken No More, became an outspoken advocate for drug policy reform after losing her son, Jeff, to an overdose in 2008.
Evidence-based harm reduction and treatment interventions are cost effective, save lives, and deliver critical resources and information to people most at risk of experiencing an overdose.
DPA is working to pass federal and state legislation that would remove barriers to effective harm reduction and treatment interventions, monitor overdose trends, support research on overdose and potential solutions, and allocate much-needed funding to support life-saving overdose prevention programs.
Methadone and Buprenorphine
Opioid agonist therapy (OAT), widely recognized as the most effective treatment for opioid use disorder, refers to addiction treatment with prescription opioid agonist medications, such as methadone and buprenorphine (Suboxone™), which block the effects of opioid use and prevent or relieve withdrawal symptoms and cravings. Scientific research has established that OAT is a cost-effective intervention that increases patient retention in treatment and decreases drug use, transmission of infectious diseases, criminal activity, and overdose deaths.
Naloxone is an inexpensive, generic drug that works to reverse an opioid overdose by restoring breath to unconscious overdose victims. It has no potential for abuse and has been used with efficacy and safety in emergency rooms and ambulances in the United States for over forty years. Nearly 27,000 people were saved from 1996 to 2014 with naloxone distributed by community-based overdose prevention programs. But, barriers to accessing naloxone remain and funding is urgently needed to ensure it gets into the hands of the real first responders – people who use drugs and their family members and friends.
Good Samaritan Laws
“Good Samaritan” laws provide limited immunity from prosecution for specific drug offenses for people who summon help at the scene of an overdose. As of July 15, 2017, 40 states and the District of Columbia have passed “Good Samaritan” laws, but these authorizations vary widely in the protections they actually provide. Good Samaritan laws need to be expanded to reduce as many barriers to calling 911 as possible, including arrest, parole or probation violations, and immigration or child welfare consequences.
Supervised Consumption Services
Supervised consumption services (SCS), also called overdose prevention centers, supervised injection facilities, or drug consumption rooms, are legally sanctioned health care settings where people can use pre-obtained drugs in a safe, clinical setting. SCSs are designed to reduce the health and societal problems associated with drug use and to engage the most hard-to-reach populations in community, treatment, and care. SCSs are proven to reduce overdose deaths and the transmission of infectious diseases while improving public order and safety.
Drug checking, also known as drug testing, pill testing, or adulterant screening, can be used to determine whether a substance is what it’s reported to be. It helps people who use drugs make more responsible consumption decisions and inform others of the risks of the tested substance. Organizations like DanceSafe sell drug testing kits to the public. Some public health departments and syringe exchange programs have also recently begun distributing fentanyl testing strips.