It has been said that the opposite of addiction is connection. Covid-19, however, has frayed societal connections. For Americans with substance use disorder, connections that were already fragile are at a serious breaking point.
The Covid-19 pandemic has resulted in an increased risk of using drugs alone, changes to the drug supply, and initiation or increased use of substances by individuals. Right now, the U.S. is facing unprecedented levels of overdose deaths, with an estimated more than 90,000 overdose deaths from October 2019 through September 2020. Driving this is the increasing availability and use — both knowingly and unknowingly — of highly potent, illicitly manufactured fentanyl and fentanyl analogues.
Faced with these facts, policymakers are asking the urgent question: How do we better protect those at risk for overdose?
Over the long term, the U.S. must take the necessary steps to build an addiction infrastructure that can prevent addiction, link people to and provide quality treatment for people with substance use disorders, and support long-term recovery.
In the short term, the U.S. needs to provide interventions at every opportunity to reduce overdose risk, meet the needs of people in treatment, and care for people who are using substances as well as those with substance use disorders who are not in treatment or in recovery. We need to bend the curve and prevent people from dying from overdoses.
This means scaling up syringe services programs (sometimes referred to as syringe exchange or needle exchange programs) to provide a connection to services and care. Such programs should include access to naloxone, a safe and fast-acting drug that reverses opioid overdoses and has saved thousands of lives nationwide. Administering naloxone to someone who has overdosed — or providing it to someone at risk of overdose or their families or friends — builds trust and provides support for people in need. Our country can also improve connections to care, particularly after an overdose, in settings such as emergency departments.
Making it easier to access fentanyl test strips is another essential step to save lives, foster engagement, and build trust with underserved and at-risk populations.
Fentanyl test strips can be used to detect fentanyl and, in some cases, fentanyl analogues, which are commonly found in the drug supply — alone and mixed with other illicit drugs such as heroin, cocaine, and methamphetamine. They are the leading driver of overdose deaths. Individuals using a drug — as well as those responding to an overdose — may have no idea that a powerful synthetic opioid is present.
Fentanyl test strips not only have the potential to reduce overdoses, but the process of obtaining them can bring individuals with substance use disorders in contact with a community organization or other harm reduction supports for the first time and can lead to reduced risk for drug-related harms and improved health outcomes.
However, federal funding for two large initiatives focused on the opioid crisis could not be used to purchase fentanyl test strips — until now.
In April, the Biden-Harris administration removed those restrictions to allow federal grantees such as state and local health departments, state substance abuse agencies, and community-based organizations and health systems receiving federal funding the flexibility to use grant dollars for this inexpensive engagement tool.
These interventions — these connections — are one way to curb rising overdose deaths. Building these connections requires funding, which is why President Biden included nearly $4 billion for behavioral and mental health services in the American Rescue Plan. Half of these funds will be spent on addiction prevention, treatment, and recovery services. Yet even with this increase in federal investment, a yawning treatment gap persists. Only 18% of people with a past-year opioid use disorder reported receiving medication-based treatment, the standard of care, in the past year.
Fentanyl test strips alone will not bridge the treatment gap or turn the tide of overdoses overnight. But they are an important part of the all-of-the-above approach that must be employed to bend the curve of overdose deaths.
Making it a priority to give people with substance use disorders every opportunity to connect with services and to be more aware of the substances they are using will slowly build bridges that meet the needs of people with addiction and ultimately save lives.
Regina LaBelle is acting director of the Office of National Drug Control Policy. Tom Coderre is the acting assistant secretary for mental health and substance use in the federal Substance Abuse and Mental Health Services Administration. Rochelle P. Walensky is the director of the Centers for Disease Control and Prevention.
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