The opioid epidemic and substance use disorders have garnered national attention as overdose deaths continue at an alarming rate. Synthetic opioids – chiefly fentanyl – are the culprit in many of those deaths.
The Commission’s report
Earlier this month, the bipartisan Congressional Commission on Combating Synthetic Opioid Trafficking, with representatives from many Federal agencies and departments, released a report detailing their proposed multi-pronged approach to addressing the opioid epidemic. Their recommendations are organized under five pillars:
- Policy coordination and implementation
- Supply reduction
- Demand reduction and public health
- International cooperation
- Research and monitoring
The report contains plenty of useful recommendations supported by strong evidence. However, we have identified some gaps and issues informed by past research and important considerations related to health equity.
The role of law enforcement and policymakers
The report implies that the optimal approach would rely heavily on policymakers and law enforcement to prevent synthetic opioids from getting into the hands of Americans. Policymakers and law enforcement should certainly have a role in the fight against the opioid epidemic. However, a law-and-order approach is punitive and could result in people finding more dangerous ways to access illicit drugs. Moreover, history suggests that the heavy hand of law enforcement would fall disproportionately on communities of color. This is counter to the Biden Administration’s focus on health equity.
According to the CDC, synthetic opioids accounted for more than 70% of all opioid-involved deaths in 2019. Synthetic opioids have become so popular because synthetics, in general, are cheaper than natural drugs, making them more compelling for people who sell drugs and more accessible to people who are purchasing them.
With synthetic opioids being so deadly, prevention methods must come from multiple angles. We must treat all the people involved as key components of a broader system. So-called “bad actors” don’t innately want to ruin other people’s lives but make their own lives better, even if only temporarily.
Here are a few recommendations to add the toolbox of strategies to combat the opioid epidemic and overall substance misuse.
Recommendation 1: Partner with local health departments and community organizations
Local health departments and community organizations have expertise in implementing evidence-based strategies to reduce drug use and drug-induced mortality. A study published in Medical Care in 2021 titled “Nonprofit Hospital Community Benefits Collaboration With Local Health Departments to Address the Drug Epidemic” observed how the Patient Protection and Affordable Care Act required nonprofit hospitals to collaborate with local health departments to address drug use. The study found that this collaboration correlated with a decrease in drug-induced mortality. Similarly, the opportunity for policymakers and health facilities to partner with community organizations can be instrumental in finding effective strategies for improving health outcomes and linking people to the resources they need.
Recommendation 2: Engage providers and improve accessibility
Prevention and treatment include having trained health care providers that feel comfortable discussing substance use with patients. It should also ensure that patients have the access to education on the proper use of substances and treatment. Opening the door for that communication is key.
A study published in Medical Care in 2020 titled “Discussing Drug Use With Health Care Providers Is Associated With Perceived Need and Receipt of Drug Treatment Among Adults in the United States: We Need to Talk” provides evidence. The researchers estimate the prevalence of drug use discussions between health care providers and individuals with past-year drug use based on data from the 2015-2017 National Surveys on Drug Use and Health. They found that having those discussions can affect people’s perceptions of need for drug use treatment and improve opportunities for them to engage in addiction treatment.
In addition to having those discussions with providers, it is critical to make sure that people can access well-trained providers and facilities. Part of the challenge with access is transportation and affordability of services. In another 2020 Medical Care study on Medicaid acceptance for substance use treatment, the authors describe how Medicaid payments could increase access to care for individuals with SUD and highlighted the importance of parity laws to improve healthcare for vulnerable populations. We have also covered the importance of expanding Medicaid to fight the opioid epidemic here on the blog.
Recommendation 3: Address root causes and meet people where they are
Treatment and policies need to be rooted in cultural humility. We must address the stigma that creates barriers to people accessing the care they need. Prevention efforts that block synthetic opioids from entering the US are important. However, other underlying issues that people are facing lead them to use substances in the first place. Individuals need trauma-informed care, access to education (especially around harm reduction), and multiple options for treatment for their health conditions to help mitigate the need for other substances.
Closing thoughts
We cannot use only punitive force if we want any major improvements to happen in our drug overdose mortality rates. Often, people use these substances to treat various forms of pain, including physical pain and emotional distress. Therefore, we must use strategies that are informed by and include the people that are most affected.
The final report from the Congressional commission was an important first step. We must go further to have a real opportunity to improve people’s lives for the better. Key to reducing opioid deaths will be involving the communities in decision-making, ensuring that people get adequate access to treatment, and remembering that every person deserves respect and care and should be treated accordingly.
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Lisa M. Lines