Opinion | More than 1 million have died in the overdose crisis, but still the response is scandalously inadequate – The Washington Post

Beth Macy, based in Roanoke, Va., is the author of “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America” and an executive producer and co-writer on Hulu’s “Dopesick” series.
A nurse practitioner I know in rural North Carolina visits his patients’ trailers and tents at night after work, dispensing tiny scraps of hope in the form of hepatitis C medications, sterile needles, Narcan for emergency treatment of overdoses and discount prescriptions for lifesaving addiction medications. An outreach worker I follow in Charleston, W.Va., struggles to track new addiction-related HIV cases because police routinely evict her clients from their encampments. Nearby, a needle-exchange operator risks arrest to distribute needles where the practice has been outlawed, giving out homemade salves concocted from foraged plants so people can heal their own abscesses.
These are measures taken by people desperately fighting, largely on their own, against a drug-overdose death toll that historically has killed more Americans than the coronavirus pandemic. Since 1996, the year OxyContin launched and the United States’ health-care system fell prey to the lie that opioid painkillers were safe for virtually everything from headaches to wisdom-tooth surgery, more than 1 million Americans have died of overdoses; the coronavirus pandemic has claimed about 850,000. During the first year of the pandemic, the Centers for Disease Control and Prevention reported a record 100,000 annual overdose deaths.
And yet, unlike at earlier points in the opioid epidemic, we now have the tools to save countless people from fatal overdoses. What is preventing these tools’ widespread use is the stigma and bureaucratic ineptitude that have always marked our relationship to those who use, and need, drugs.
Beth Macy discusses this piece in more detail on James Hohmann’s podcast, “Please, Go On.” Listen now.
When the coronavirus hit, the United States saw stadium and arena parking lots turned into mass testing sites and then vaccination clinics; doctors who hadn’t performed primary care in decades stepped in to take care of covid-19 patients; companies accustomed to letting China manufacture their goods suddenly swung into action to make personal protective equipment (PPE).
But with an even more lethal overdose crisis — and that’s not counting all the addiction-related deaths from hepatitis, endocarditis and suicide — the nation’s leadership appears capable of only minor tweaks.
Some blue-leaning states and cities now offer evidence-backed practices such as supplying drug users with clean needles and fentanyl test strips, and even offering medically supervised spaces to inject illicit drugs — all of which foster important connections to professional care and wraparound services. But in much of the world’s richest nation, where a few million Americans suffer with opioid use disorder, these measures remain anathema.
The pandemic-prompted loosening of federal regulations for the telehealth prescribing of buprenorphine, the lifesaving addiction medication, has been a bright spot, particularly for rural people who have long struggled with transportation issues. But that policy change remains temporary and the treatment gap (with an estimated 10 to 12 percent of addicted people receiving treatment in an average year) has barely budged.
Too many health-care providers remain unable to identify and treat drug addiction because they refuse to meet patients, mentally and physically, where they are.
Not long ago, I got to witness a trained peer-recovery coach at work behind the front desk of a federally qualified health center in a small North Carolina town. “What are you here for today, honey?” Nicole Montelongo said cheerfully to a slump-shouldered, middle-aged woman. The patient had been circling the counter for an hour, mustering the nerve to approach a health-care system that had overprescribed her opioids then abandoned her the moment she became addicted to them.
The woman whispered that she was an IV heroin and methamphetamine user, had lost custody of her children and was living on the edge of town in a tent. (She’d borrowed a car to get here.)
“I’m so happy to see you,” Montelongo said, sharing that she, too, was once addicted to meth. Then she arranged for the woman to see a practitioner, who spent the next several months meeting the patient in her tent or at a nearby gas station — treating her with psychiatric, addiction and hepatitis meds and, when she asked for Narcan and other safe-injection supplies, giving them to her, no questions asked.
The health-care term for that approach is “low-barrier treatment,” yet it in my six years of reporting on the opioid epidemic, I have seldom witnessed such attention and care.
This is a crisis that has pounded a third of American families and helped drive a 40 percent decline in workforce participation among prime-age men. With President Biden’s family connection to addiction, I had hoped he would demand that his Office of National Drug Control Policy treat the overdose crisis as the emergency it is. But stagnation continues.
Epidemiologists predict that by 2029, U.S. overdose deaths will have doubled to nearly 2 million. Until we stop arresting and abandoning people who use drugs and start meeting them where they are with treatment and compassion, rare will be the family that remains untouched.
Beth Macy discusses this piece in more detail on James Hohmann’s podcast, “Please, Go On.” Listen now.


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