P.A.A.R.I. cofounder and chair John Rosenthal today had an opinion piece published in the Boston Globe calling attention to the 100,306 Americans who died of drug overdoses from April 2020 to April 2021, as the COVID-19 pandemic overshadowed the overdose epidemic.
There have been and continue to be effective treatments, such asmethadone, buprenorphine, and extended-release naltrexone Vivitrol for some substance use disorders. However, our systems of care have failed to take urgent steps to employ them, and hospital emergency departments continue to lack the capacity, or the desire, to treat patients with substance use disorders.
While there are effective medication treatments for opioid and alcohol dependence, as exist for other chronic diseases, there remains an urgent need to put overdose blocking naloxone, commonly known as Narcan, in the hands of every first responder and family with a loved one suffering with opioid addiction — while we also develop therapies for stimulant dependence. Our law enforcement partners tell us that for every overdose death there are 9 to 10 overdose reversals with naloxone. There would have been about 1 million deaths instead of the more than 100,000 overdose deaths last year without naloxone.
America’s response, albeit delayed, to the HIV/AIDS epidemic resulted in the HIV Cascade of Care Continuum, which has had extraordinary outcomes at reducing stigma and driving down infection and death. More recently, the response to COVID-19 has been similarly extraordinary. In relatively short order, vaccinations were developed, and our systems of care adapted. Health care providers, from primary care to neurosurgery, quickly trained in the fundamentals of the disease.
Our health care system can react similarly to substance use disorder but has chosen not to. The health care and health insurance systems are a significant barrier to access to treatment and medications. Almost 4 in 5 Americans with the disorder receive no treatment, and even fewer receive medications for treating it.
Shockingly, those with substance use disorder are increasingly more likely to access treatment and receive medications while they are incarcerated than while in the community. That is unacceptable. Access to medication-assisted treatments in the community must be expanded, because we know that those receiving medications have a significantly reduced risk of fatal overdose.
Clinics, hospitals, and drug treatment programs must be incentivized and required to provide medication-assisted treatment for substance use disorder. In fact, existing and unenforced federal law already requires such level of care. Hospitals and other medical providers must stop shirking their responsibility to help people in need. Restrictions on Medicaid for people who are incarcerated should be waived so there’s no gap in coverage when they return to the community. Research has shownthat people with SUD who are released without treatment are 50 times more likely to overdose and die.