Fatal drug overdose has reached epidemic levels in the U.S., surpassing vehicle-related deaths in 36 states, according to a new report from the Trust for America’s Health and Robert Wood Johnson Foundation. In a separate study, researchers found that drug overdoses in the United States tripled in the last 25 years.
The two-fold tragedy of the epidemic in the United States is that overdose deaths are preventable, and they often start with good intentions: Both reports concluded that increasing abuse of prescription opioid painkillers are to blame for these staggering numbers.
"Our health professionals' well-intentioned approach to treating people’s pain can sometimes lead to unintended consequences and exposing an individual to the risk of addiction or overdose," Dr. Hillary Kunins, assistant commissioner at the New York City Department of Health and Mental Hygiene, told The Huffington Post. Indeed: In a small-scale study published in the journal Substance Abuse and Rehabilitation, 40 percent of injection drug users abused prescription opioids prior to starting heroin.
A series of public health initiatives to address this mounting problem, coupled with a slowly changing attitude toward addiction, have started to move the dial on preventing future overdoses. Here are five harm reduction initiatives that could reduce overdose deaths:
1. Needle exchange programs
Giving drug users clean needles for free might seem counterintuitive, but in addition to helping stem the spread of infectious diseases like HIV, needle exchange programs can actually curb drug use.
These programs provide free, non-judgmental health services to drug users in addition to clean needles, thus drawing the drug-using community into a health care space that could eventually lead to treatment and recovery programs.
"We can use needle exchanges almost like a net to move [drug users] into more comprehensive approaches, so that they hopefully become abstinent through biomedical and behavioral approaches that we know work," Adam Carrico, an assistant professor at the University of California, San Francisco, who focuses on the intersection of drug abuse and HIV, told The Huffington Post in March.
2. Anti-addiction medication
A year-long HuffPost investigation into the heroin epidemic in Kentucky revealed that the medical community largely agrees that Suboxone, a drug that blocks the effects of heroin withdrawal and curbs cravings, is the most effective treatment for heroin and opioid addiction.
"It’s not even controversial," Dr. Bankole Johnson, professor and chair of the department of psychiatry at the University of Maryland School of Medicine, told HuffPost's Jason Cherkis in January. "It’s just a fact that this is the best way to wean people off an opioid addiction. It’s the standard of care."
Suboxone can be particularly instrumental in preventing the relapses that are common in the weeks following rehabilitation. These relapses make drug users particularly vulnerable to overdose, since they have a lower drug tolerance after treatment.
3. The rescue drug Naloxone
An overdose antidote that's long been available in medical settings, naloxone is now a focus of public health efforts. Over the last few years, community and public health groups have created programs to teach lay people how to recognize overdoses and administer the drug. Through either nasal spray or injection, it reverses the effects of opioids such as prescription painkillers or heroin.
"Naloxone works by basically kicking off these opioids from the receptors, or where they bind in a person’s brain," Kunins told The Huffington Post. Perhaps most importantly for a drug administered by lay people, naloxone is foolproof: "It does not have a harmful effect in a person who has not taken an opioid, or who has taken an opioid," she added. "If a person does not have opioids in their body, naloxone simply won’t have any effect."
Shoshanna Scholar, executive director of the LA Community Health Project, can attest to the success of her program's naloxone initiative on a micro level. "We trained 652 people last year. There were 77 lives saved with the naloxone that we gave out," she told The Huffington Post.
— NYPD 121st Precinct (@NYPD121Pct) June 3, 2015
The first responders to the scene of an overdose are often police officers, not EMTs. In New York City, 420 people died of heroin overdoses in 2013, the highest number of overdose fatalities from the drug in a decade, the New York Times reported.
In response to the epidemic, the NYPD launched a pilot program in one precinct in each borough in the fall of 2013, training officers to administer nasal naloxone. The next year, the program was expanded to the city at large, according to the Staten Island Advance. New York's state-wide Community Overdose Prevention initiative, which also employs naloxone, has saved more than 100 lives since it was initiated last year.
5. Laws protecting "Good Samaritans"
According to the Drug Policy Alliance, most deaths occur between one and three hours after an overdose, and immediate calls for medical help greatly reduce a person's chance of permanent physical damage or death. But many people who witness an overdose fear arrest or punishment -- and as a result, they don't call for help.
Good Samaritan laws provide limited immunity from drug prosecution for individuals who call 911 or otherwise provide help to an overdose victim. As of June 2015, 28 states had Good Samaritan protections on the books, seven of which were passed this year.
While these each of these five measures above have done a lot of good in local communities, a bigger and more unified effort is needed to reverse the distressing national trend of overdose deaths. "It’s tricky business because there’s a huge patchwork of legal remedies," Scholar said. "There’s no consistency.”
But between bystander policies such as Good Samaritan laws and increased public access to life-saving treatments like naloxone and Suboxone, we have a good start.
Do you or some someone you know need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.