From 2000 to 2014, nearly half a million people in the United States died from drug overdoses. The nation has made significant strides in battling this epidemic, but we need to do more.
Today, International Overdose Awareness Day, is a good time to explore comprehensive strategies to reduce drug addiction, which is one of Community Catalyst’s goals. The aims of this day include remembering those who have died or been permanently injured as a result of drug overdose, and showing that the tragedy of overdose death is preventable. Most national attention has focused on naloxone (brand name Narcan), a lifesaving opioid overdose antidote, which counters the effects of an opioid overdose by allowing the victim to breathe normally. The antidote has been used for several decades by emergency medical personnel, but in recent years, the focus has been getting naloxone into the hands of people who use drugs themselves as well as their friends and families. Studies have shown that providing opioid overdose training and naloxone kits to such nonprofessionals who might witness an opioid overdose can help reduce deaths, and that naloxone distribution to drug users is cost-effective.
Naloxone is an essential step in a larger strategy. But it is under attack.
But few people who use drugs would knowingly risk death, especially given that naloxone puts opioid users into withdrawal and makes them violently ill. Naloxone does save lives, and is not a crutch for people who have problems with drugs to use in riskier ways. For some, being revived after an overdose is an intervention point for treatment. However, we know it’s not a panacea either. We recommend a multifaceted approach that seeks to prevent and treat addiction, reverse overdoses, and help people access services to lead healthier lives.
An essential component of addressing addiction is starting early, before people transition to problematic use. We promote using Screening, Brief Intervention, and Referral to Treatment (SBIRT), a public health approach that involves health professionals asking young people a few questions about drug and alcohol use, and providing guidance or referring them to treatment if a problem exists. By providing a space where young people feel comfortable discussing their substance use, trusted adults can abandon the ineffective “Just Say No” paradigm. Instead, they can seize the opportunity to discuss the problems alcohol and drug misuse can cause in a health-centered and compassionate way, and recommend further counseling and treatment. By not waiting until a tragic event occurs, this approach can ultimately prevent overdoses among young people.
Another important step is ensuring that treatment is accessible, evidence-based and good quality. And a third step is supporting approaches that promote support over punishment. People with severe substance use disorders who have experienced an overdose need more community-based supports, ranging from health to social to economic services. This is especially true given that prior overdose is the strongest predictor of future overdoses. Therefore, we promote comprehensive programs for people at risk of arrest or jail because of drug-related behaviors — programs that divert them into health and social services. In these pre-arrest diversion programs, case managers work with participants to understand their multifaceted health problems and develop individualized care plans. This participant-centered approach focuses largely on what individuals believe they need to improve their health, and case managers serve as advocates, coordinating and securing the services they need.
On International Overdose Awareness Day, we want to send a strong message to current and former drug users that they are important members of our communities. At Community Catalyst, whether we are advancing programs and policies that create safe spaces for young people to talk about drug use, or strengthening the continuum of community-based services for people at risk of incarceration, we do so because we think everyone deserves access to quality health care, and that our health system needs to better serve all vulnerable populations.