People are dying at record rates from opioid overdoses, and harm reduction advocates are asking the Biden administration to overhaul how it deals with the crisis.
by Michelle ChenTwitt
Part 2 - Turning a Corner
Though the pandemic has aggravated the opioid overdose epidemic, the Biden administration has signaled a shift in Washington’s approach to the crisis. The massive American Rescue Plan stimulus bill includes a tranche of $30 million dedicated to harm reduction services. That’s a tiny fraction of the $7.6 billion the federal government spent on the opioid overdose crisis in fiscal year 2019. But Beth Connolly, project director of the Substance Use Prevention and Treatment Initiative at Pew Charitable Trusts, said that as the first explicitly targeted federal funding for harm reduction, “it really is a message and a step in the right direction.”
The harm reduction provision in the relief package could boost federal support for syringe service programs (SSPs), which provide clean needles to injection drug users and are highly effective in preventing disease transmission. Amid the rising opioid death toll and associated spread of hepatitis infections, the number of states with legislation directly authorizing needle exchange nearly doubled between 2014 and 2019 to 31 and Washington, D.C. But many state governments have failed to adequately fund the programs, and in some cases, state and local authorities have hampered their work with onerous federal and local restrictions on syringe distribution and policies that criminalize the carrying of unauthorized needles. Meanwhile, the number of SSPs nationwide declined during the pandemic, from an estimated 406 in 2020 to 378 in 2021, and the existing programs serve only a tiny portion of the demand for clean needles.
Harm reduction experts also want to see an expansion of access to Naloxone, an overdose-reversal drug that is delivered easily through a simple nasal pump. While Naloxone is legal to use in all states, some states restrict who can administer it, for example by barring distribution by “lay people” who are not licensed medical personnel.
Congress is weighing legislation to expand MAT access nationwide. Many public health and drug-policy reform organizations have pushed for the Mainstreaming Addiction Treatment (MAT) Act, which would eliminate a requirement that doctors obtain a special credential known as an X-waiver in order to prescribe buprenorphine. Introduced earlier this year by Representative Paul Tonko (D-N.Y.) and Senator Maggie Hassan (D-N.H.), the measure could save an estimated 30,000 lives per year, according to the advocacy group End SUD (Substance Use Disorder).
A parallel bill, the Medicaid Reentry Act, would connect incarcerated people to Medicaid services in the month prior to reentering the community, to avoid a gap in health care coverage that is linked to high overdose rates post-incarceration. The days following release are extremely precarious for people with opioid use disorder, as they often have a reduced tolerance to the drug after being locked up; ensuring that they have medical care post-reentry could stave off fatal overdoses.
“What’s so critical for any disease is early intervention,” said Courtney Hunter of the advocacy network Shatterproof. “And what we’re doing now is we’re treating addiction at stage four—in emergency rooms, after somebody’s overdosed.… Nobody’s treating addiction at stage one, and that’s what we need to be doing to have better outcomes and to save lives.”
“What’s so critical for any disease is early intervention,” said Courtney Hunter of the advocacy network Shatterproof. “And what we’re doing now is we’re treating addiction at stage four—in emergency rooms, after somebody’s overdosed.… Nobody’s treating addiction at stage one, and that’s what we need to be doing to have better outcomes and to save lives.”
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