Don't blame fentanyl for overdose deaths, blame barriers to treatment
By Jessie Dunleavy
Sep 03, 2018 at 6:00 AM
Last week, my son’s name was read aloud, and a dove was released to honor his memory, in a community in Colorado Springs, where he used to volunteer. Even though this ceremony was more than 1,600 miles away, it was the highlight of my day, worthy of two Facebook posts.
For those of us who have lost a child, we cling to the smallest things, allowing us, in some way, to hold on to our loved one. But I’m also clinging to something big: the reform needed to diminish preventable deaths such as my son’s, and to spare the lives and the anguish of so many who are fighting to live and deserve care.
Maybe reducing the skyrocketing overdose death toll on a national level is unrealistic at this time. So I look to my beloved state of Maryland, where I have lived all of my life and where my son was born and died. Mirroring the country, Maryland’s overdose deaths have steadily increased over the last four years, reaching an all-time high in 2017 — 2,282 overall and 2,009 opioid related — a number that includes my son and one that nearly doubled in just a few years. But there are states, as reported by the Centers for Disease Control, where these tragic deaths are actually decreasing. Not confined to a particular region, these states — Hawaii, Massachusetts, North Dakota, Oklahoma, Rhode Island, Utah, Vermont, and Wyoming — give us hope.
The focus on combating this deadly calamity needs to extend beyond curtailing prescription medication for chronic pain patients. In fact, I think we have thrown the baby out with the bathwater in too many instances — causing pain sufferers to turn to suicide or the “dark net,” while overdose deaths continue to climb. Knowing that 75 percent of those who died from a drug overdose were not recipients of prescription medication makes these often heartless restrictions hard to understand. While it’s important to have oversight of the pharmaceutical companies, and to alert all of us to keep our prescribed medication out of the reach of others, these initiatives are not targeting the heart of the immediate crisis.
The single biggest solution to ending this overdose epidemic is not complicated: access to medical treatment that includes the option for medication. Effective in stabilizing people in recovery, and FDA approved, medications such as buprenorphine (also known as Suboxone) have proven to cut the death toll by 50 percent or more. But government restrictions — requiring doctors to obtain a waiver to prescribe these life-saving medications and capping the number of patients they can treat — limit access for the vast majority of those in need. The states in the lead on reducing the death toll have worked within these restrictions, prioritizing increased access to medication assisted treatment. Think of the lives we could save nationwide if these senseless restrictions were lifted.
In France, the overdose death toll dropped by 79 percent just four years after the government lifted restrictions, allowing primary care doctors to prescribe buprenorphine. It’s no surprise that in short order more than half of those suffering from addiction were in treatment with an outcome that speaks for itself.
Complicating all of this is health insurance. In spite of the federal government initiatives to cut back on health insurance for the needy, Maryland has expanded Medicaid through the Affordable Care Act — meaning it has a lower percentage of uninsured than the nation as a whole, something it has in common with the majority of states that have reduced the number of overdose deaths, and something that makes me proud.
I do know there are harm reduction initiatives afoot in Maryland, including safe stations and increased availability of the anti-overdose medication naloxone; but I do not see much, if anything, about efforts to increase access to the single most effective resource — medication-assisted treatment.
It’s painful for me to read that Maryland officials, in acknowledging the state’s increase in overdose deaths, cast the blame on fentanyl. Because my son was unable to get the inpatient treatment needed to stabilize his recovery, he and I together sought a doctor to prescribe Suboxone. We failed, and days later he resorted to street drugs, dying of mixed drug with fentanyl poisoning. He never would have encountered fentanyl if he had access to the treatment he wanted.
If fentanyl is the enemy, we should do everything humanly possible to keep those who want help away from it. As it is, government restrictions that preclude medical treatment are allowing fentanyl to flourish in our communities.