Opioid fight shows glimmers of progress
War on overdose deaths includes policing with naloxone, giving inmates medication-assisted treatment, and expanding Medicaid: Our view
With drug overdoses now America’s leading accidental killer, cities and states have been struggling to find some way — any way — to curb the loss of life. A handful have found flickers of hope. The common thread? A willingness to try unconventional solutions and the fortitude to handle the political heat that often follows.
For glimmers of progress, look to a police chief who isn’t afraid to sound more like a public health advocate than a tough law man; to a prison medical director with a pioneering program to treat inmates; and a Republican governor who expanded Medicaid in the face of opposition from his own party.
There’s no easy way to stop opioid overdose deaths, which reached 47,600 across the nation last year. But creative, concerted efforts have begun to make a dent, even in some of the hardest hit areas:
►In Burlington, Vermont, a city of about 42,000 without a health department, Mayor Miro Weinberger and Police Chief Brandon del Pozo have partnered to flood the community with naloxone, a drug that can bring victims of opioid overdoses back from the brink of death.
Del Pozo has no patience for stock solutions that don’t work. In October, he posted on Facebook that he’s tired of arguing with other sheriffs who don’t want “their deputies carrying naloxone” and “getting mocked by reactionaries because I won’t arrest desperate people for using nonprescribed addiction treatment meds.”
Burlington has joined with the Johns Hopkins Bloomberg School of Public Health to use science-based methods, including connecting people — whether in the emergency room or at needle exchanges — with long-term treatment. Vermont has made that easier with a model hub-and-spoke system, where hubs are treatment centers and spokes are smaller clinics and physicians who ensure that treatment continues in the community.
►In Rhode Island, a pioneering program to provide inmates with medication-assisted treatment has reduced overdose deaths by more than 60 percent among recently released inmates, who are particularly vulnerable. Inmates who’ve been abstinent leave prison with a lower tolerance and can easily overdose if they relapse, which they often do.
Every individual who enters prison or jail is tested for opioid use disorder and offered counseling plus approved medications to lessen opioid cravings. Medication-assisted treatment is considered by doctors and other experts to be the most effective. While early results are based on a small sample, the decline marks astounding progress among a group that is often missed.
►In Ohio, which ranks second highest in the nation for its drug overdose death rate, Republican Gov. John Kasich wisely took advantage of the Affordable Care Act to expand Medicaid for low-income Ohio residents. With thousands more addicted people accessing treatment through Medicaid, the state has been free to use other federal funds to support such things as stable housing for patients coming out of rehab and opportunities for employment.
“What keeps people in recovery is hope that life can be better,” says Mark Hurst, director of the Ohio Department of Mental Health and Addiction Services.
Meanwhile, a handful of cities and counties are using innovative programs that show promise. Hamilton County, home to Cincinnati, has dramatically cut opioid overdose deaths by more than 30 percent during the first six months of a program that has distributed more than 28,000 doses of Narcan, a nasal spray form of naloxone, to the public. Now, not only first responders, but also friends and families of addicted people, can save lives. Follow-up includes connecting people with medication-based treatment.
Such treatment remains controversial, foolishly maligned as enabling people to continue a drug habit. But just as no one would deny a diabetic treatment with insulin, no one should deny those with an opioid use disorder necessary medication, three types of which have been approved by the Food and Drug Administration.
Hard-hit Dayton has added another ingredient, sending teams of police officers, social workers and people who are successfully going through treatment to the homes of those recently rescued from an overdose. Peers can often persuade someone to get treatment when others fail.
All this has led to signs of progress — a statewide decline of 40 percent in overdose deaths in the first five months of this year compared with the same period last year in Ohio, according to preliminary figures.
Nationally, opioid deaths increased last year, driven by fentanyl, a powerful synthetic opioid often laced into painkillers or heroin. There is no time to waste. Every day that government officials shy away from commonsense, science-based solutions, 130 more people succumb to opioid overdoses. But maybe, just maybe, this awful epidemic has crested.