Recent scientific projections indicate the opioid overdose crisis will worsen between now and 2025, and dramatically so. According to the mathematical modeling published last month in JAMA Network Open, the annual death toll will exceed 80,000 and could, using the most pessimistic scenario, reach 198,000.
I hope we take action now to defy these odds, but I worry we are stuck — stuck because rampant misunderstandings promote confusion. Given the severity of the crisis, it surprises me that so many who could affect change still understand so little about it.
One example of confusion surrounds reductions in prescription of certain medication, which gets a lot of news coverage and has been a legislative focal point. Yet the onset of addiction among recipients of prescribed medication is about 10 percent, and for those without previous drug use it's less than 1 percent. Maybe this explains why, in spite of the steady decline in opioid prescriptions over recent years, overdose fatalities have continued to surge.
The JAMA study, conducted by experts from Harvard Medical School and Massachusetts General Hospital, concluded: "Prevention of prescription opioid misuse alone is projected to have a modest effect [3.8 percent decrease] on lowering opioid overdose deaths. Additional policy interventions are urgently needed" — including improved access to science-backed addiction treatment and the full range of harm reduction services.
While these initiatives call for a comprehensive and integrated response, moving forward on them is not beyond our capability. And our lawmakers hold the cards.
In the United States, treatment for a substance use disorder has no standards or regulations that providers must meet or that families can consult. It's no surprise, then, that this absence of oversight has enabled the proliferation of programs that operate without medical expertise or resources, often giving family guidance that is counter to scientific evidence and with outcomes that do more harm than good.
Clinical diagnostic expertise and professional medical, as well as psychological, care are critical. A substance use disorder is a medical condition, and is rarely the only ailment with which the afflicted contend. Yet it is the only medical condition for which patients are unable to get help in the emergency room or from their primary care doctor. And it certainly is the only medical condition where the remedy is often found in prayer, or where shaming and punishment are routine responses to a setback.
Given the overwhelming abundance of research concluding addiction treatment with either buprenorphine or methadone reduces overdose fatalities by 50 to 70 percent, this option should be readily available and explained to every patient at the outset of treatment. The misunderstandings about medication for addiction treatment baffle me. In fact, it seems it would be illegal to treat someone for any condition without informing them of proven life-saving medication.
Treatment programs that operate outside the medical system do not offer these medications, neglect to speak of their benefits and often instill unfounded fear of them. Adding to the obstacles, federal laws require doctors to take a course to be certified to prescribe buprenorphine, then limit the number of patients they can treat. Other countries lifted such restrictions, years ago, and overdose deaths have plummeted.
Just as troubling on the treatment front is the cry for "more beds" and the hand-wringing that understandably accompanies the reality of financial constraints. For people who have a home, a stable place to live, outpatient treatment and ongoing care from a physician is often superior to inpatient treatment and far less expensive. Furthermore, 28-day detox programs are statistically proven to be dangerous and not supportive of long term recovery.
Equally urgent are improved harm reduction services. Instituted throughout the world, a full range of these initiatives includes overdose prevention sites, needle exchange programs and access to supplies that minimize the risk of drug use. Based on a deep commitment to public health and human rights, harm reduction saves lives and reduces the societal assault of criminalization.
I am very proud of Maryland for the bill introduced in this legislative session to authorize a pilot program for overdose and infectious disease prevention sites. In addition to providing needed medical care, these sites bring drug users out of the shadows, providing the doorway to treatment and a productive life. With 120 such sites around the world, there is conclusive evidence on the enormity of their life-saving impact.