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Two years into the opioid emergency

Two years ago the Trump administration declared the opioid crisis in the United States a public health emergency, positioning federal agencies to respond to what has been called the public health crisis of our time. Congress followed, appropriating billions of dollars to federal agencies and state and local governments to support a variety of programs to address opioid addiction treatment and overdose prevention.

What have we accomplished in the two years since the president’s declaration? A lot depends on what we define as an accomplishment, but I have seen many. While the opioid response remains a work in progress, states and territories have demonstrated positive momentum in ways that has benefited individuals, families, and communities nationwide. This includes expanded access to addiction treatment and recovery services; reductions in opioid prescribing; faster, better, more accurate prescription drug monitoring programs; more research on pain management and alternative treatments for pain; and state health agency standing orders expanding access to overdose reversal medication and a U.S. Surgeon General’s advisory for all Americans to carry it (I was able to get mine hassle-free for a $35 co-pay at my local pharmacy).

Several states are also reporting decreases in overdose deaths in the last two years, encouraging news that hopefully will become a national trend. While we are seeing decreases in the prescription overdose death rate, many people are continuing to die from illicit opioid overdose, including heroin laced with fentanyl.

As prescription opioids become harder to acquire, states have seen increases in the use of illicit drugs and increases in infectious diseases from injection drug use including HIV and Hepatitis C. This is a concerning trend that we need to monitor very closely. Similar to the Scott County, Indiana HIV outbreak from 2011 to 2014, West Virginia and several other states are currently experiencing a rise in HIV rates among people who inject drugs. States are also facing crises from substances other than opioids, including other drugs such as methamphetamine, cocaine, and benzodiazepines.

So, are we any closer to ending the opioid crisis two years after the emergency declaration?

As someone who works with public leaders across the country, I see lots of bright spots: places where state and territorial health leaders are doing great work that is indeed making a difference by making recovery and treatment more available to the people that need it. We need more of those places, but we are indeed making progress.

That said, there is an urgent need for more leadership and financial resources to expand public health efforts to prevent addiction in the first place: what public health professionals call primary prevention. Primary prevention includes programs and policies that mitigate the impact of adverse childhood events and adverse community experiences by building individual, family, and community wellness and resilience.

Emerging research demonstrates that preventing adverse childhood events can lower the risk of someone developing a substance use disorder (and several other chronic diseases). When families and communities have the resources they need we see substance misuse, suicide, violence, and a host of other issues become less prevalent. In order to fully address this crisis, we must address the impact of stress in young children, work with schools and school-age children, build resilient communities, and increase investment in programs that work to address the other influences on health, like meaningful employment, safe communities, and access to stable and secure housing.

Eliminating the stigma associated with substance use disorder is another area where we need more work. Stigma is a long-standing public health problem because it keeps people from seeking the treatment and recovery supports they need for fear of job loss, family separation, criminal prosecution, or just labeled an addict.

A national effort to change the narrative of addiction from a focus on someone’s moral “failing” to an emphasis on addiction as a chronic brain disease will help support people who may be afraid to seek treatment today. We can all work to change how we talk and think about people living with substance use disorder. Former White House Office of National Drug Control Policy Director Michael Botticelli led the charge to change how we talk about addiction sharing  that language reflects our belief system and we cannot end the opioid crisis if we refer to those impacted the most as junkies or addicts.

As we reflect on two years of progress, we must continue to respond with the resources necessary to ensure that proven prevention, treatment, and recovery services are available consistently, regardless of where one lives. To do that, we need to work with other government agencies, healthcare providers, law enforcement, as well as local, state, and national organizations to counteract stigma and view addiction as a chronic health condition that affects the brain. If we apply appropriate, evidence-based strategies, addiction is both preventable and treatable. Preventing individuals from misusing opioids and other substances in the first place is the best way to end our nation’s opioid emergency and improve the health of all Americans.

Featured Image: Aerial View via Unsplash

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