MGH expert responds to 100,000 overdose deaths – Harvard Gazette
The Centers for Disease Control and Prevention recently reported that the number of overdose deaths in the United States exceeded 100,000 for the first time in a 12-month period, ending in April. The grim milestone represents an increase of almost 30 percent from the previous 12-month period. Fentanyl, 100 times more potent than heroin, and other synthetic opioids have been linked to the majority of deaths, and experts say COVID-related isolation and anxiety reversed pre-pandemic progress against opioid abuse.
The Gazette spoke with Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital and Associate Professor at Harvard Medical School, about what can be done to save lives. The interview has been edited for clarity and length.
GAZETTE: What is fueling the increase in overdose deaths?
WAKEMAN: The crisis and its worsening are linked to several factors. One is the continued unpredictability and poisoning of the illicit drug supply. Increasingly, the drug supply is contaminated with fentanyl, and there is a lot of unpredictability in what people are consuming.
You can compare it to alcohol, for which we have a regulated supply. Of course, we always worry about alcohol use disorders and we identify and treat them. But if you go to a restaurant, bar, or store and drink alcohol, you know the alcohol level based on the volume of the product you consume. But imagine you order a drink and it could be 5% beer or 80 degree alcohol – that would be a huge difference, and you would have no idea how to regulate that.
GAZETTE: What about the effects of COVID?
WAKEMAN: An ongoing meta-problem, even before COVID, was this growing unpredictability of drug supply and the backdrop of decades of policy approaches that failed to support or adequately fund effective treatment or harm reduction interventions. to reduce overdose deaths. And then COVID came along and amplified things in a number of ways. First, it is the increase in trauma, social isolation, loss of economic opportunity, boredom, hopelessness, all of these factors that we know can increase chaotic substance use. It has also made it more difficult to access some of the treatments and resources that keep people safe. For example, many of the harm reduction interventions we recommend for people, such as never using alone or seeking treatment services, have become much more difficult in the days of COVID. And fundamentally, I think we are seeing the end result of years of unsuccessful policies and approaches to thinking about drug use and addiction and how we should address these complex public health challenges.
The other part that has been really crucial to note is the deepening racial disparities in the overdose crisis. In Massachusetts between 2019 and 2020, there was a 75% increase in opioid-related overdose deaths among black men. I think the public discourse has been that this problem only affects white communities. But the reality is that black communities are ravaged by overdoses, and the health harms of racism are increasingly evident in the overdose crisis. This is in addition to the fact that many of these communities have already been devastated by the failed and racist war on drugs, resulting in the separation of families by the child welfare system, people sent to prison, incarceration. instead of processing.
GAZETTE: Men aged 24 to 54 have been the most affected by the wave of overdoses. What is your response to this statistic?
WAKEMAN: I think these are young people with decades of life ahead of them, and I think about what went wrong: the supply strategies. This strategy is “just making it harder for people to get in” – a focus on opioid prescriptions, border crackdowns, increased funding for the DEA, and increased criminal prosecutions for drug-related charges – was totally ineffective. Yet that’s what we keep hearing about, even now in 2021, and that’s where our funding is headed.
I find a useful framing is “recovery from what to what?” What does someone really need in order to recover? And what is their hope for recovery in the future? If you are not housed, if you do not have a job, if you have gone back and forth through the criminal justice system, if you have been treated terribly by the systems, if you have been the victim of racism, if you have you have no hope for anything, why would you stop using drugs? Drugs are the only thing that will allow you to cope with this reality. And if you use drugs, what strategies can we implement that we know will reduce your risk of dying?