Overdose awareness impels us to counter the stigma of addiction

August 31^st is International Overdose Awareness Day, a day set aside to commemorate family, friends, and members of our community whose lives were lost due to drug overdoses.  It is also a day where we commit to take action to end the opioid epidemic.

Observances of Overdose Awareness Day tend to be low key in the United States, as the stigma and shame faced by people in recovery, or those who have lost loved ones, often keep such observances in the shadows. 

{mosads}The US House passed many pieces of legislation this year to address the opioid epidemic, and the Senate is expected to take up its version of the opioid package in the coming month.  These pieces of legislation contain laudable provisions to expand treatment access, provide recovery supports, and initiate other policies to bring down the rates of overdose death and help those in need.

What legislation can’t do however, is address the stigma that remains attached to those suffering from the disease of addiction.  This stigma has driven, and continues to drive, much of our policy response to addiction.

Removing stigma is the responsibility of each one of us.  One step that everyone can take is to change the words we use when we talk about substance use disorders.  The Harvard professor John F. Kelly has written that using terms such as “abuser”   or “addict” can result in punitive responses.  Everyone who has the disease of addiction, including those with chronic substance use disorders, deserves our attention, compassion, and health care.  They are not past the point of help, but like anyone with a chronic condition, caring for that person may require a different response.

Beyond changing the language of addiction, there is more that we can do, and words must be accompanied by action. These actions must include providing an array of opportunities to intervene and help those with the disease of addiction.  Early intervention is critical, but insufficient.  Opportunities for intervention can take place in emergency departments after an overdose, or when a patient is admitted to a hospital due to other consequences from a substance use disorder.  Intervention opportunities also exist in correctional facilities and upon reentry. And further interventions can be found in drug user health facilities that serve people with chronic conditions who may not otherwise seek out help, or who don’t access care in the mainstream health care system.  These facilities can provide care to some of the most disenfranchised members of our communities.  Drug user health facilities recognize that someone with the chronic disease of addiction often has complex needs that won’t be resolved quickly or easily.

Preliminary overdose data from the CDC showed 2017 was another year where overdose deaths increased.  This increase comes despite considerable federal and state funding going toward the epidemic, as well as falling opioid prescribing rates. To curb the opioid epidemic, an all-of-the-above approach is required.  

Preventing new cases of opioid misuse by reducing rates of opioid prescribing remains a focus, but additional interventions are needed to help people across the entire continuum.  Take for example the state of Rhode Island.  Rhode Island implemented a program of medication assisted treatment in their state correctional system for the incarcerated population with an opioid use disorder.  The results were remarkable.   Overdose deaths among newly released individuals decreased, and this also resulted in a decrease in the number of overdose deaths in the state.  Rhode Island is one of only three states in the Northeast to have had a decrease in overdose deaths in 2017, even in the face of increasing rates of illicit fentanyl use in the region. Rhode Island’s program was initiated despite reluctance to provide people who are incarcerated with medications for their opioid use disorder, a reluctance based partly on concern over diversion as well as the stigma attached to medication assisted treatment.

On this Overdose Awareness Day and going forward, remember the lives lost.  But just as important, let’s remember to continue to take action so next year’s Overdose Awareness Day can mark the beginning of the end of the epidemic.

Regina LaBelle, J.D., served as Chief of Staff and policy advisor at the Office of National Drug Control Policy in the Obama administration. She is currently a public policy consultant and Visiting Fellow at the Duke Margolis Center for Health Policy.