U.S. ignores opioid treatment evidence in favor of the status quo

The number of opioid-related drug poisoning deaths in Maryland for the first quarter of 2019 is lower than a year ago. Still, it’s the second highest in over a decade, and, mirroring 2018, we are losing on average 40 Marylanders per week.

Tragically, these deaths of our loved ones are preventable, intensifying the pain for families and the loss for society. Evidence shows that most people who experience addiction do recover and go on to lead productive lives — outcomes that aren’t sensational enough to warrant much press coverage.


In the perilousness of our current reality — with street drugs easier to access than health care and laced with unknown synthetics and potency — people are dying at a pace we couldn’t have fathomed 10 years ago. And they are dying before getting the chance to recover.

The research is conclusive and has been for years. To overcome this surge in fatalities and support the path to recovery, we must get over our fixation on abstinence as the only worthy goal and provide low threshold access to evidence based medications (buprenorphine, methadone) and other harm reduction initiatives that minimize the dangers of drug use in an unregulated market.


As this epidemic ravishes our communities, nimble responses are crucial. But we are slow to change, reluctant to adopt harm reduction programs despite compelling data of lives saved elsewhere.

There are people who care about this horrendous loss of life, some are well-informed and working hard. Yet without systematic coherence, needed services remain chronically inadequate with delays that are deadly.

To what do we attribute the failure to join forces and provide desperately needed health care? In a word: stigma.

It’s impossible to overcome stigma in the face of criminalization. Often derailing focus on the harm suffered by our fellow humans is an emphasis on the crime of drug use. We measure our success in the amount of illicit drugs confiscated or the number of arrests, while the death toll hovers at the same percentage.

Harm reduction initiatives are based on patient-centered care, compassion and respect for human rights — values that don’t hold up against the negativity espoused by opponents whose mantras sanction callousness among policy makers and much of the public. While there are pockets of exceptions for aspects of harm reduction, most are tabled and many are fought, with the Department of Justice addicted to waging the war on drugs.

Rather than enhancing access to FDA approved medications that have slashed fatalities in other countries, our federal government actually impedes access with policies that mandate doctor-waivers, limit the number of patients and restrict locations. There is no logical or scientific explanation for such barriers nor are they applied to other medical conditions—those without stigma, those for which we are not conflicted about whether to treat or to criminalize people who suffer.

The concept of harm reduction has caught on worldwide and saved countless lives. Primary in this movement has been the distribution of needles for injection drug use, preventing the spread of infectious disease. The U.S. was slow to adopt this practice when faced with the AIDS epidemic in the 1990s, costing thousands of lives, and prompting activists to take on the cause and ultimately prevail.

Today, syringe programs are legal in Maryland, yet this service is currently operating in only six counties (out of 23) and Baltimore City. Witnessing the snail’s pace at which we provide common-sense health care is discouraging, particularly in light of the hope to expand harm reduction services to include overdose prevention sites, places where people can use drugs in a hygienic environment with trained personnel and immediate access to life saving interventions.


While such programs initially seem counterintuitive, they have been successful in reducing infectious disease, preventing overdose deaths and providing connections needed to move those who struggle into treatment. With over 100 such sites throughout Europe, Australia, and Canada, the data speaks for itself in terms of plummeting fatalities and increased public awareness of addiction as a medical condition rather than a moral or legal issue.

While the U.S. tends to ignore evidence in favor of the status quo, there is hope. Overdose prevention sites are being planned in several locations including Philadelphia; and the Maryland Legislature will consider a pilot program that could well be a breakthrough in our efforts to address this public health crisis with needed expertise and compassion.

Jessie Dunleavy is a writer and substance use disorder activist. She can be reached at