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The writer is a contributing columnist, based in Chicago
For more than half a century, the United States has waged a “war on drugs.” Yet overdose deaths are reaching record levels, even reducing life expectancy in the United States. Six times as many Americans died from drug overdoses in 2021 as in 1999, according to the U.S. Centers for Disease Control and Prevention, with 111,000 people dying in the year through April 2023, according to preliminary figures from the CDC.
The risk of dying from an accidental opioid overdose is now higher than the risk of dying from a car crash, according to the U.S. National Safety Council.
American states and cities are frantically tackling the crisis and experimenting with potential solutions. Emergency overdose boxes appeared at my local library and senior center; vending machines filled with Narcan — the naloxone nasal spray that can reduce opioid overdoses — are being installed in some Chicago subway stations; and my local pharmacy started selling Narcan without a prescription, right alongside Halloween candy and Covid tests.
But decades of experimentation – from clean needle distribution sites to drug courts to decriminalization of possession of small amounts of drugs – have not eliminated this scourge on lives and society. In recent years, the crisis has been fueled by synthetic opioids like fentanyl, which are far more powerful and dangerous than heroin. U.S. states and local governments are expected to receive more than $50 billion over the next two decades from legal opioid settlements with drugmakers and middlemen, but addiction experts say it is not clear how most of this money will be used.
Alex Elswick, who became homeless because he developed an opioid addiction after wisdom teeth extraction, tells me his mother was unable to get him Narcan when he was actively addicted in 2012 Elswick, who just celebrated 10 years of recovery, said he and his mother formed the nonprofit Voices of Hope of Kentucky, primarily to distribute Narcan. He is happy that mothers like his can now buy it at the pharmacy.
But addiction experts agree that the list price of $44.99 for two doses of the drug will put it out of reach for most who need it, and cities like Chicago are expanding programs to distribute it for free. Despite this, “making them available without a prescription will continue to change the conversation about opioid use.” . . and destigmatize it,” says Sarah Richardson of the City of Chicago’s Substance Abuse Team. Pharmacists in Illinois have been allowed to dispense Narcan without a doctor’s prescription since 2017, she told me, and many insurance companies cover the cost. But having to contact the pharmacist still remains a barrier for many.
Christopher Jones, director of the drug prevention center at the U.S. Substance Abuse and Mental Health Services Administration, says he carries naloxone with him everywhere and thinks overdose emergency kits should be as common in public places as automated external defibrillators for heart attacks.
“Naloxone is just one piece of the puzzle,” he told me. “Opioid-related deaths are complex. . . the problem needs to be addressed holistically, including addressing underlying mental health issues. SAMHSA recently said that 94 percent of people with substance use disorders in the United States haven’t received treatment, but that’s because most don’t want it. “We need to raise awareness,” says Jones.
But Elswick is among a growing number of people in the addiction treatment community who believe the focus needs to shift away from what he calls the “single story of recovery” based on abstinence, usually through a 12-step program. He says the goal of the “harm reduction” movement is to “reduce harm, not drug use” – through measures such as distributing naloxone and providing clean needles. “People recover in different ways,” he says.
Most people agree that wider distribution of life-saving overdose treatments is a good idea — but that’s where the agreement ends. The forces in America’s war on drugs today are divided between those who still want to lock up drug users; those who want them to become pure; and those who want to help them use drugs more safely.
And so the fight continues, while the death toll rises.