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The opioid epidemic is just not unsolvable

Last week we received terrible news: In 2020, the number of deaths from drug overdose in the US reached its highest ever recorded level – more than 93,000 according to preliminary federal data.

And then we got some more terrible news this week: Life expectancy in the US has dropped 1.5 years – the worst drop since World War II. Most of this is due to Covid-19. But part of it was driven by the rise in overdoses.

All of this means America is facing a major overdose crisis right now, as it has been for more than two decades.

But that’s not because we don’t have solutions to the opioid epidemic. There are strong evidence policies that can be broken down into four categories:

1) Restriction of the supply of medicines: One reason people become addicted to drugs is because they have access to them in the first place, through prescription (OxyContin and other pain relievers) or on the street (also prescription drugs, but also heroin or fentanyl).

Part of the solution could therefore be efforts to restrict access to medicines, including a reduction in opioid prescriptions, law enforcement efforts to disband and dismantle drug markets, trade policies, border control measures and international cooperation.

This is not enough to defeat drugs forever. But a study of the heroin drought in Australia in 2001, when police action severely curtailed heroin supplies, found that this led to a reduction in drug-related problems.

2) More and better addiction treatment: There are great treatment options for opioid addiction. Decades of evidence show that drugs like methadone and buprenorphine cut patient death rates by half or more and keep patients on treatment longer.

But treatment remains inaccessible to many. There may not be a provider in your area. What exists can become extremely expensive. And the treatment offered may not be evidence-based at all.

Experts say a variety of fixes are needed. The government should spend a lot more on treatment and build it where it is not readily available. Insurers, including public programs, should cover them. Regulators should ensure that treatment is of a decent standard – which is definitely not the case in many places today.

3) Mitigation: Some people will do drugs. Harm Reduction recognizes this and works to reduce the harms of drug use and keep people alive, hopefully until they are ready to stop using them.

For example, needle exchange provides sterile syringes so people don’t share or reuse needles, as reuse can lead to infection or the spread of disease. Decades of research show that needle sharing stops the spread of disease, reduces the number of syringes in public spaces, and connects more people to treatment without allowing for more drug use.

Several other approaches are available, such as the provision of the opioid overdose antidote naloxone, monitored points of consumption, and the administration of heroin to treatment-resistant patients. Some of these ideas definitely contradict the Puritan attitude of many Americans towards drugs in general, but there is evidence that they can save lives.

4) Fix the causes: People are more likely to use drugs when they find themselves in desperate situations where drugs are one of the few sources of pleasure or relief they can get (as the classic Rat Park experiment showed). Virtually any approach that supports the poor and disadvantaged can lead to long-term reductions in drug use.

This is the lowest evidence category, in part because it is difficult to study the effects of an intervention decades later. It’s a long-term approach too, so it probably wouldn’t do as much to halt the current drug crisis as it would future ones.

Here’s the good news: most of these ideas are covered in President Joe Biden’s Plan to End the Opioid Epidemic. It’s just a matter of Biden and Congress prioritizing this plan or something like that.

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