A year ago, voters were promised revolutionary changes and a shake-up of the status quo. At the receiving end of this promise was a class of Americans who felt they had been left behind; it seemed the economy didn’t have room for them and the government no longer cared. This hopelessness was particularly acute in addiction-ravaged industrial and manufacturing towns across the country. Drug deaths around the country were rising at extraordinary levels. In 2016 alone, 64,000 Americans died from drug overdoses and over two million more were dependent on painkillers. But a year later, promises have fallen to the wayside; pleas have gone forgotten – human destruction in the form of addiction has remained unaccounted for.
It is easy to abhor and take umbrage with the Administration, which declared a health emergency in response but offered no pragmatic solutions. And, at this point, with greater salience given to addiction, it is easier to identify the issue at hand (I attempted to do so last year). It is much more difficult to formulate a coalition and a response that properly addresses addiction in our country’s diverse communities. Nevertheless, some cities and states have responded, and it is critical to recognize where their efforts have succeeded and what policies might be implemented at a broader level.
Some prisons are adjusting the way inmates with addiction are handled. It has been found that a majority of prison intakes have drugs in their system, and the number of incarcerated addicts is only escalating with the rise of opioid and heroin use. One prison in Kentucky has found that 83 percent of intakes suffer from an opioid or heroin addiction. This Kentucky prison is using incarceration as an opportunity for rehabilitation: providing treatment experts, mandating support groups, and offering Vivitrol to inmates before their release, which inhibits the effects of opioids and heroin for up to thirty days. This program has reaped hopeful results. Before implementing the addiction treatment program, there was a 70 percent rate of recidivism; now, for those who go through treatment, recidivism has dropped to 10 percent. The success of this particular program, and others like it, have inspired states to explore the possibility of implementing similar programs.
Many other states have begun mandating clinicians to report opioid prescriptions to prescription drug monitoring programs (PDMPs). These programs require prescribers to report opioid prescriptions to an online database that is accessible to clinicians around the state. Mandated reporting ensures that patients with addiction do not shop for prescriptions from multiple providers and places the onus on clinicians and their prescribing practices. PDMPs have contributed to a remarkable reduction in the number of opioids prescriptions in various states and have witnessed declines in overdose deaths. In Florida, opioid prescriptions declined in most counties by 80 percent, while overdose deaths declined substantially as well. Similar results were identified in Tennessee and New York where there was, respectively, a 36 percent drop and 75 percent drop in ‘opioid shopping.’
In Philadelphia, a method is being tested to confront addiction by implementing a ‘warm-handoff program,’ a strategy that directly connects overdose survivors at emergency departments with treatment programs. Research indicates that individuals who overdose and are discharged from emergency departments experience a higher risk of repeat overdoses, affording this method a critical opportunity to prevent subsequent overdoses and guide those suffering from addiction through the treatment process.
Although these potential solutions might seem hopeless with the growing preponderance of families affected by addiction, there are remedies worth exploring that offer, if anything, seedlings for hope. States like Ohio and New Mexico have sued pharmaceutical companies for “fueling the opioid epidemic;” insurance companies have been exploring the consequences of pre-authorization measures on prescribing practices and treatment options; and justice systems are redefining the role they play in addiction-related cases. As a society it seems we have finally begun to understand addiction as the disease it is, instead of the crime it is not.
There is no doubt that opioid and heroin addiction continues to cripple communities and families around the country. A pragmatic federal response has failed to manifest, but American cities and states are devising thoughtful plans to lessen the toll of rampant addiction. It is becoming apparent that the Administration will not solve this problem by its own impetus; therefore, it is pertinent to demand a proper response, which considers successful current programs and policies, from our local leaders.