When is it going to stop?

Earlier this month, NCADA announced that the St. Louis region set yet another record in opioid overdose deaths. Days later, we learned that in Missouri, a statewide record had also been set. One morning last week, five people in the same home overdosed and were revived with naloxone. Public response ranges from blame and anger, to confusion and outright exasperation: “When is it going to stop?”

It’s not an easy question to answer. In fact, it’s not even easy to answer the question: “When did it start?” Did it start in the 1970’s when the War on Drugs turned addiction into a criminal justice problem and moral failing, instead of a public health issue? Did it start in the 1990s when Purdue Pharma introduced OxyContin and promoted it as non-addictive and safe for long-term use? Did it start in 2001 when the Joint Commission and medical lobbying groups made pain the fifth vital sign? Did it start in 2005 when Mexican drug cartels, in response to the U.S. liberalizing its marijuana laws and creating a large market for cheap, potent American-grown marijuana, began plowing under marijuana fields and planting opium poppies? All of these complex, nuanced factors played a role, just as there will be many complex, nuanced factors that will play a role in ending this opioid crisis.

So, when is it going to stop?

It will stop when we focus our efforts on youth, and invest in prevention. Preventing young people from developing substance use disorders is by far the most effective and cost-effective strategy to end this crisis. For example, when caregivers have early conversations with their kids about alcohol and other drugs, the risk of later drug use drops by 50%. That’s why we launched the Talk About It campaign; to give parents the tools to navigate these seemingly difficult and intimidating conversations.

We know that evidence-informed, universal, school-based prevention works. By building resiliency skills and emotional competence in kids starting in kindergarten, and providing drug-specific information to older students, we help kids manage their emotions and the pain they’ll face in life, and we empower them to postpone their first use of alcohol or other drugs. We know that the longer they wait, the more they reduce their risk of ever developing a problem with substances

However, we also understand that we will never be able to prevent all substance use problems. Prevention is only half the answer. Substance use disorder is a mental health issue—a chronic, recurring brain disease—and we must commit the resources to treat it the way we treat other chronic health conditions: aggressively, with specialized care, for many years.

This epidemic will stop when we commit to treating opioid use as the brain disease it is, and not as an individual weakness or fault. Too often we see or hear comments such as “well, just stop using.” Telling someone with a substance use disorder to “just stop” is like telling someone with depression to “cheer up”. At best, it’s not helpful. At worst, it can exacerbate the problem. That’s why NCADA has counselors who provide assessments and referrals for treatment, or information and support to those trying to help a loved one find recovery from a substance use disorder.

Evidence shows that medications like Suboxone, Vivitrol, and methadone dramatically increase success rates in treatment. These medications are ideally paired with psychosocial therapy and recovery supports, including working with peers. A massive investment in treatment is needed to eliminate deadly waiting lists. Some progress has been made on that front, but still, nine out of ten people who need treatment are not getting it.

The epidemic will slow when we commit to addressing opioid use disorder from a public health perspective. This means we have to engage in strategies that are proven to prolong survival. Having naloxone (Narcan), the overdose reversal medication, available is the single best strategy to save lives and give people a chance at finding recovery. We hear people lament that naloxone is an “enabler,” that there should be consequences to drug use. We reply that Naloxone enables people to survive, and that death should never be the result of a treatable mental health disorder.

Until the broader community understands that addiction is a mental health condition and supports evidence-based interventions to address it, the overdose numbers will continue to climb and we’ll be powerless to arrest this worsening tragedy.

The good news is that we know what works and what will work. The utilization of evidence-based strategies, when broadly and aggressively deployed, will end this epidemic.

But when? It’s hard to predict. But to the extent that there’s anger and exasperation, it might better be directed at government policy makers and those controlling the purse strings than at those millions of people wrestling with an active addiction. This remains an underfunded and misunderstood public health emergency.

Categories: Commentary

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