https://www.cdc.gov/opioids/basics/epidemic.html
Decades after the deadliest drug overdose epidemic in American history, people continue to die from overdoses at higher rates than ever before. According to data from 2017 to 2021, the number of opioid overdose deaths increased from 47,600 to 80,411 — far more than the number of Americans killed each year by firearms or in car accidents. The rise in deaths is largely attributed to the use of synthetic drugs such as fentanyl, which is 50 times stronger than heroin.
Preliminary statistics from the Centers for Disease Control and Prevention point to nearly the same number of opioid overdose deaths in 2022 — 79,770. At the same time, the number of overdoses among blacks, American Indians and Latinos is rising even faster, widening the gap in deaths between whites and people of color. In 2020, black men aged 65 and older were seven times more likely to die from overdoses than white men of the same age.
The number of Americans facing addiction to opioids remains high. According to the Substance Abuse and Mental Health Services Administration's latest annual study, 6.1 million people age 12 and older will suffer from an opioid use disorder in 2022, and 8.9 million reported opioid abuse in the past year.
Preliminary statistics from the Centers for Disease Control and Prevention point to nearly the same number of opioid overdose deaths in 2022 — 79,770. At the same time, the number of overdoses among blacks, American Indians and Latinos is rising even faster, widening the gap in deaths between whites and people of color. In 2020, black men aged 65 and older were seven times more likely to die from overdoses than white men of the same age.
The number of Americans facing addiction to opioids remains high. According to the Substance Abuse and Mental Health Services Administration's latest annual study, 6.1 million people age 12 and older will suffer from an opioid use disorder in 2022, and 8.9 million reported opioid abuse in the past year.
«Most people recover. That's something we don't often talk about when discussing the opioid crisis» — said Sarah Wakeman, senior medical director for substance use disorders at Massachusetts General Brigham and Women's Health.
When «most people» are referred to, they are referring to those who are in long-term medication-assisted treatment (MAT), which is considered the best way to deal with drug dependence.
This method includes regular counseling and behavioral therapy, as well as the use of methadone or buprenorphine-based medications (most commonly known as Suboxone). Both drugs contain synthetic opioid substances that prevent withdrawal and drug cravings, and reduce the risk of overdose by 76%. Another drug, though less commonly used, is naltrexone, which blocks the effects of opioids.
The MAT philosophy differs from traditional rehab programs and 12-step programs that were popular in the last century. In the early 2000s, when buprenorphine was approved by the Food and Drug Administration and federal law authorized its prescription to primary care physicians, a new vision of addiction treatment began to take shape.
When «most people» are referred to, they are referring to those who are in long-term medication-assisted treatment (MAT), which is considered the best way to deal with drug dependence.
This method includes regular counseling and behavioral therapy, as well as the use of methadone or buprenorphine-based medications (most commonly known as Suboxone). Both drugs contain synthetic opioid substances that prevent withdrawal and drug cravings, and reduce the risk of overdose by 76%. Another drug, though less commonly used, is naltrexone, which blocks the effects of opioids.
The MAT philosophy differs from traditional rehab programs and 12-step programs that were popular in the last century. In the early 2000s, when buprenorphine was approved by the Food and Drug Administration and federal law authorized its prescription to primary care physicians, a new vision of addiction treatment began to take shape.
Medication-assisted alternative therapies dramatically changed the approach to treatment. As Wakeman argues, every overdose death has become a tragedy, not because addiction is incurable, but because effective treatments now exist.
Nevertheless, why are we still failing to address or at least slow down the opioid crisis?
Why do so few people with opioid use disorders get access to evidence-based treatments like MAT?
As a society, we have spent over a hundred years studying and developing policies, systems, and penalties to combat the problem of addiction, treating it as a moral issue. Although we are now beginning to see it as a public health issue, our approaches and funding still reflect the notion that people are doing something wrong and should suffer severe consequences for it.
This punitive thinking leads to an overemphasis on detoxification, which psychiatrist and neurologist Walter Ling of the University of California, Los Angeles, argues is the most lucrative but least effective method of recovery. Walter Ling's research helped the FDA approve buprenorphine and other opioids.
However, many rehab centers still focus on detoxification instead of medication-assisted treatment (MAT). A 2020 study of residential treatment programs found that only 29% offered a long-term MAT option. While the 2021 study found that only one in eight adolescent treatment centers offer buprenorphine for long-term treatment.
Physician and anthropologist Kimberly Sue, author of Destruction: Women, Incarceration and the American Opioid Crisis, tells the story of young men incarcerated at Rikers Island whose families turned their backs on them because of their drug use. She suggests that American society is extremely punitive, blaming people for failures and denying them the right to a healthy life because of drugs.
Our approach to treatment is inconsistent with scientific knowledge of what is truly effective. Without medication support, treatment for opioid addiction remains ineffective. Yet we continue to adhere to our philosophy and ideology while ignoring scientific evidence. This is reflected in interactions with the medical system and structural barriers such as racism and poverty, deepening the problems for the most vulnerable populations.
However, many rehab centers still focus on detoxification instead of medication-assisted treatment (MAT). A 2020 study of residential treatment programs found that only 29% offered a long-term MAT option. While the 2021 study found that only one in eight adolescent treatment centers offer buprenorphine for long-term treatment.
Physician and anthropologist Kimberly Sue, author of Destruction: Women, Incarceration and the American Opioid Crisis, tells the story of young men incarcerated at Rikers Island whose families turned their backs on them because of their drug use. She suggests that American society is extremely punitive, blaming people for failures and denying them the right to a healthy life because of drugs.
Our approach to treatment is inconsistent with scientific knowledge of what is truly effective. Without medication support, treatment for opioid addiction remains ineffective. Yet we continue to adhere to our philosophy and ideology while ignoring scientific evidence. This is reflected in interactions with the medical system and structural barriers such as racism and poverty, deepening the problems for the most vulnerable populations.
Dysfunctional addiction
Over the past two decades, the face of opioid addiction in America has changed. A dramatic increase in overdoses among whites and those living in rural areas has sparked a shift in public discourse. Experts and politicians began discussing «deaths of despair» among white working-class people, bringing media attention to the issue. A realization emerged that addiction should be viewed as a disease, not a crime.
However, despite this change in thinking, the treatment paradigm does not fit the situation. Methadone regulation limits access to treatment. Patients can only get the drug at federally certified clinics, usually located in high-crime or low-income neighborhoods. They must visit the clinic daily for an extended period of time before they are allowed to take home a dose. This becomes an obstacle because of the need to spend a lot of time in lines, miss work and appointments, and provide childcare. Some even have to make long commutes to work across state lines.
Over the past two decades, the face of opioid addiction in America has changed. A dramatic increase in overdoses among whites and those living in rural areas has sparked a shift in public discourse. Experts and politicians began discussing «deaths of despair» among white working-class people, bringing media attention to the issue. A realization emerged that addiction should be viewed as a disease, not a crime.
However, despite this change in thinking, the treatment paradigm does not fit the situation. Methadone regulation limits access to treatment. Patients can only get the drug at federally certified clinics, usually located in high-crime or low-income neighborhoods. They must visit the clinic daily for an extended period of time before they are allowed to take home a dose. This becomes an obstacle because of the need to spend a lot of time in lines, miss work and appointments, and provide childcare. Some even have to make long commutes to work across state lines.
Unlike methadone, buprenorphine is available from doctors and pharmacies without such restrictions. Although the risk of methadone overdose is slightly higher, the regulation of this drug remains a result of stigma rather than scientific evidence. The drug began to be used to treat opioid addiction in the 1960s, but due to societal preconceptions of addiction as a crime rather than a disease, it remains restricted in the United States to this day. While in other countries such as Canada, the UK, and Australia, methadone has long been used and distributed in medical settings.
Very long lines in front of methadone clinics are the main reason why people refuse treatment with this drug or do not start it at all. Because of such restrictions, methadone is considered hated among drug addicts, according to sociologist David Frank of New York University, who himself has been taking methadone for 20 years and is on the road to recovery.
In recent research he conducted, one participant described methadone treatment as «liquid handcuffs», while another shared a humiliating experience where she had to keep waiting in line even after she stepped away to use the restroom. Frank noted that treatment does not address people's real needs, but rather is a barrier to meeting them. Most patients seek help not for abstinence or addiction recovery, but to cope with the criminalization of the drugs they use.
Very long lines in front of methadone clinics are the main reason why people refuse treatment with this drug or do not start it at all. Because of such restrictions, methadone is considered hated among drug addicts, according to sociologist David Frank of New York University, who himself has been taking methadone for 20 years and is on the road to recovery.
In recent research he conducted, one participant described methadone treatment as «liquid handcuffs», while another shared a humiliating experience where she had to keep waiting in line even after she stepped away to use the restroom. Frank noted that treatment does not address people's real needs, but rather is a barrier to meeting them. Most patients seek help not for abstinence or addiction recovery, but to cope with the criminalization of the drugs they use.
Providers note that the strict regulations stem from the history of methadone use, when its use was common among black Americans. FDA approval of buprenorphine 40 years after methadone faced an opioid crisis affecting whites. Addiction physician Paul Joudry of Pittsburgh, who is a member of the National Methadone Liberation Coalition with Frank, notes that perceptions of methadone are frozen in the past.
Buprenorphine use is more common among white communities, while methadone clinics are more likely to be found in neighborhoods with black and Latino populations. White, affluent, and educated patients are more likely to receive buprenorphine, while patients of color are more likely to be referred to methadone clinics. Even when patients of color receive buprenorphine, their course of treatment is usually shorter.
Buprenorphine use is more common among white communities, while methadone clinics are more likely to be found in neighborhoods with black and Latino populations. White, affluent, and educated patients are more likely to receive buprenorphine, while patients of color are more likely to be referred to methadone clinics. Even when patients of color receive buprenorphine, their course of treatment is usually shorter.
Our ideas about what recovery means still reflect a stigmatized and criminalized history of addiction. Many believe that using buprenorphine or methadone for recovery is not true recovery, but merely replacing one addiction with another.
Some experts point out that drug addiction affects the body and brain in such a way that it is impossible to simply «get back on track» after quitting drugs. For some people, taking drug therapy can last for years or even decades, which is considered normal.
Some experts argue that recovery does not necessarily mean complete withdrawal from drugs. The main goal is for patients to be healthy and able to lead fulfilling lives. For some, this may mean complete sobriety, while for others it may mean moderate drug use. It is important to support patients' individual goals and help them gradually implement changes.
Harm reduction measures such as safe consumption sites, needle exchange, naloxone and fentanyl testing are becoming increasingly popular among drug treatment providers. They are aimed at minimizing the harmful effects of drug use, rather than forcing complete withdrawal. It is important to find approaches that work best for each individual, give them choices and support them through the process of change.
Some experts argue that recovery does not necessarily mean complete withdrawal from drugs. The main goal is for patients to be healthy and able to lead fulfilling lives. For some, this may mean complete sobriety, while for others it may mean moderate drug use. It is important to support patients' individual goals and help them gradually implement changes.
Harm reduction measures such as safe consumption sites, needle exchange, naloxone and fentanyl testing are becoming increasingly popular among drug treatment providers. They are aimed at minimizing the harmful effects of drug use, rather than forcing complete withdrawal. It is important to find approaches that work best for each individual, give them choices and support them through the process of change.