Incrementalism is insufficient
Why combating the country’s addiction crisis requires sweeping change
The holiday season often brings out the best in ourselves and our fellow Americans. Of course, there are some unpleasant byproducts that many of us deal with as we celebrate and travel to visit loved ones – longer lines at airports, more traffic on the interstates, and the occasional awkward conversation with relatives over holiday dinners. But by and large, things just feel a little, well, happier this time of year.
Usually, anyway.
This year, the truth is that many people are far from a place of joy. It’s not just that we still find ourselves in the midst of the COVID-19 pandemic; it’s that the pandemic has worsened an already existing crisis – one that many of us have been trying to draw attention to for years.
For the first time in American history, over 100,000 of our fellow citizens died of drug overdoses in a one-year period (from April 2020 to April 2021). It’s a grim milestone and one that, in all likelihood, was reached at least in part as a result of the emotional and mental toll that the pandemic took on the population. It is also a milestone that builds on the shocking number of deaths of despair the country has seen in growing numbers for many years. This year’s total continues a trend line that has shown consistent increases in lives lost. These alarming statistics do not even account for other deaths we have been tracking – deaths like suicide and complications related to alcohol consumption.
Addressing the broader addiction problem was hard enough and something our country had never really mastered. Now, that endeavor has been made a bit more difficult by the rampant availability of synthetic opioids. These synthetic opioids are lab made, not plant based, and hundreds of times more potent. They are driving up overdose deaths and have even been found in commonly consumed recreational drugs. These spikes have been reported in every state in the country.
It should go without saying that as a matter of human concern, this news is a national tragedy. As a policy outcome, it is totally unacceptable.
Nearly seven years ago, the Department of Health and Human Services issued a report stating their prioritization of the opioid epidemic and commitment to working towards curbing both opioid abuse and overdoses. Federal personnel and resources have been allocated to track the epidemic, respond to overdoses, decrease the opioid drug supply in circulation, and crackdown on the supply chain of illegal drugs being produced domestically as well as imported.
But herein lies a major problem – we began a solution based on an assumption that if we got the supply side under control, the demand side would go down. For opioids, at least, that wasn’t the case. People who were unable to get opioids went to other substances like heroin or synthetic opioids and because of a variety of factors, including the aforementioned potency issue, they died from overdose.
Suffice to say, these latest numbers demonstrate that current policies intended to address this worsening crisis have come nowhere close to achieving their stated goals. This is a moment, then, that calls for us to go big.
Now, more than ever, we are in dire need of what Well Being Trust and Trust For America’s Health called for over 3 years ago - a National Resilience Strategy – one that can begin to tackle the root causes of this epidemic. In order to be successful, this strategy must be extensive and comprehensive, with an evidence-based set of plans. And what should those plans place an emphasis on? There are three things in particular that could drive a more successful national response to the opioid crisis:
A focus on prevention. The best way to end an addiction is to keep one from starting in the first place. To that end, law enforcement must work at every level to limit the supply of dangerous drugs like heroin and fentanyl. Schools and health organizations should implement robust educational programs to inform the public about the risks posed by opioid use. Perhaps most controversially, we must address community factors like housing, employment, transportation, connection, belonging – deeper issues that far transcend just being able to access care.
Improving mental health and addiction services to focus on “whole health.” There must be an expansion of mental health and substance use disorder treatment and recovery options that address a “whole health” mentality, designed to end the stigmas that surround both addiction and mental health struggles. We must stop pretending that we can treat addiction without simultaneously addressing any underlying mental health issues that may also be present (and vice versa). Integrating services is a positive step forward – but it’s just a step as our systems and structures have repeatedly neglected these services for decades, making it harder for a person to get their “whole health” needs addressed.
Make integration of care the standard of care. It’s no surprise that accessing mental health and addiction treatment can be difficult. As the data show, most people don’t get the help they need, leading to a variety of additional problems. But we do know that when we bring care to where people are, they are more likely to engage in that care. From primary care to schools to their homes, we should have mental health and addiction help everywhere people are.
Along the way we should also embrace harm reduction approaches like what New York City did this past week. Anything and everything to keep our eyes on saving another life.
Together, this kind of sweeping approach could begin to put the country on the right track.
This holiday season, while we continue to navigate the ongoing effects of the COVID-19 pandemic, we cannot let this latest news fade away. Every one of these deaths from the opioid epidemic is a national tragedy, and more could have been done to prevent each one. If anything, this is a time for frustration and a time to speak out on the need for change. It is long past time for large-scale, comprehensive, and systemic action.