Over the last several years, many journal articles and opinion pieces have been written outlining the steps policymakers should take in the face of increasing rates of overdose deaths and decreasing life expectancy. Having worked on the opioid epidemic first in the Obama administration and now at Georgetown University’s O’Neill Institute, I believe there are five basic issues that must underlie any response aimed at curbing overdose death rates.
First, we must address stigma
The stigma that attaches to people with substance use disorders pervades every aspect of society, from criminal justice, to our health care system, schools, the media. No segment of our society is exempt. Stigma manifests itself in the names we use to refer to people with the disease of addiction, to the criminalization of the very behavior that is a consequence of the disease. Stigma shows up in surveys of health care professionals who prefer not to treat people with substance use disorders, as well as the general public who believe addiction is a moral failing.
Each one of us has a role to play in reversing this stigma. And it should start by thinking about our own attitudes toward substance use disorders, how we talk about people with the disease of addiction and the types of policies we support.
Second, our nation must embrace harm reduction efforts
Harm reduction efforts are common in our society. In cars, seat belts protect us from traffic crashes due to reckless driving, just as helmets protect cyclists. Our society embraces such efforts because they protect us from injury and promote safety. But harm reduction efforts for people who use drugs are not looked at in quite the same light. Opposition to syringe services programs continue and are not limited to one geographic area of the country.
In both Orange County, Calif. and West Virginia, local elected officials have opposed syringe services programs due to misconceptions about them and the people who use them. Unfortunately, their opinions reflect the feelings many harbor toward drug users and their health care needs. We know syringe services programs can help guide people to treatment and reduce transmission of bloodborne diseases. Yet too many communities still believe they will attract unsavory people and enable drug use. Until we embrace these types of harm reduction efforts, we will not move beyond today’s addiction epidemic.
The third area needed to address the opioid epidemic includes building alliances
Building alliances is directly related to decreasing stigma and embracing harm reduction efforts. Alliances between the public health and public safety communities can create partnerships that are both life-saving and life-changing, for everyone involved. The opioid epidemic provides us the opportunity to bridge divides that seemingly separate us from one another. Shared problems can lead to shared solutions if we listen without judgment.
Fourth, while the nation justifiably is focused on ways to decrease opioid involved overdose deaths, public policies and funding should be broad enough to address all substances, both legal and illegal.
For example, there are over 88,000 deaths attributed annually to excessive alcohol use in this country. While still other states grapple with methamphetamine and cocaine use. We must make certain that our public policies are tailored and evidence based to address today’s drivers of overdose death, but not be so narrow that the social determinants that underlie all forms of substance use disorders are not considered.
Lastly, as the federal government continues to invest in long-term research, promising practices at the local level must be supported
In the wake of three years of decreasing life-expectancy linked to the opioid epidemic, there is an urgent need to act expeditiously and lift up promising practices. An example of such a practice is the medication first model in Missouri where people are provided low barrier access to medication assisted treatment. Policymakers should look for opportunities to support this type of promising practice while exploring ways to remove roadblocks that prevent broader adoption.
Removing stigma, supporting science, best practices and evidence, are things that every policymaker can do — today — to make a difference in the opioid epidemic and to address all forms of substance use disorder.
Regina LaBelle is a distinguished scholar and director of the addiction and public policy initiative at Georgetown University Law Center’s O’Neill Institute for National & Global Health Law.