White House Opioid Commission Blows Teachable Moment

The White House Commission on the opioid crisis released its final report on November 1st. The report contained a range of recommendations including increasing the number of drug courts and launching a public campaign to prevent abuse of opioids and to challenge the stigma associated with its use.  

While much of the focus on the Commission’s final report is understandably on critiquing its recommendations, there is a larger issue at play—what is absent from the report altogether. The Commission blew an opportunity to share with the public what is well-known and understood by public health and addiction experts on the frontlines of the opioid epidemic—that there are proven harm reduction and treatment interventions that will be far more effective at curbing overdose fatalities than any supply reduction or enforcement strategy.

By adopting an integrated approach to prevention, education, harm reduction, including ensuring widespread distribution of naloxone, and evidence-based treatment it is possible to dramatically reduce the number of deaths related to opioid use.

Prevention programs should focus on empowering and educating people, especially young people who are dying preventable deaths, about opioids. While understanding the root causes of problematic drug use is complicated, educating and empowering those who use or may be considering using opioids is a move away from the hopelessness that appears to be driving opioid use in young people.

What we do know is that campaigns based on orders to “just say no” fail in part because they do not engage young people or provide realistic and safe options for people who may choose to use despite potentially negative consequences.

Harm reduction strategies and programs have a strong track record of improving the health of people using opioids and preventing overdose deaths.  There are a wide range of well-established harm reduction practices.  Some are as simple of teaching young people how to stay safe when partying. Other proven measures are setting up safe consumption sites, enacting Good Samaritan laws that encourage people to seek help when someone is in distress without fear of punishment and ensuring that people in the best position to reverse an overdose—people who use drugs themselves or their friends and families—have easy access to the overdose antidote medication naloxone.

Another life-saving harm reduction technique is to give people who use opioids a means of testing the substance they are using to see if it has been adulterated with fentanyl or some other substance that could lead to an overdose or other adverse reaction.

Harm reduction programs enable people with expertise in drug use to engage with those who are using problematically, earn their trust, and potentially guide them toward voluntary treatment programs. Judgment and the threat of being punished for drug use drives people who use drugs underground and into greater danger of an overdose or other adverse reaction. Harm reduction, on the other hand, saves lives.  And yet, the term “harm reduction” is not even mentioned throughout the Commission’s 100+ page report.

There were, however, some glimmers of hope in the Commission’s recommendations, such as calling for increased access to evidence-based addiction treatment with medications such as methadone and buprenorphine. But, there are serious reservations about how President Trump’s analysis will influence the implementation of even the best recommendations and legitimate concerns that ramping up a failed war on drugs will lead to more preventable deaths.

Punitive responses to opioid drug use, including the promotion of drug courts which are integrated into the criminal justice system, not only fail to protect the lives of people who use drugs, but by portraying opioids and fentanyl as “bad” drugs, people seeking palliative care are also made to suffer. Opioids, including fentanyl, can be used to great effect therapeutically. Opioids can also lead to deadly overdoses. Doubling down on a punitive approach to drug use will impact both people’s access to pain medicines as well as their willingness to voluntarily seek help and treatment for any problematic drug use. Creating drug policies that are grounded in public health principles and informed by compassion, not judgment, means that the government can implement measures that save lives and reduce suffering.

This piece originally appeared on the Drug Policy Alliance blog.

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