Public policy on fentanyl is due for a stigma audit

This was originally published for Hazelden Betty Ford’s monthly Recovery Advocacy Update. If you’d like to receive our advocacy emails, subscribe today.

By Emily Piper

Those of us in the addiction care field know we have a public policy problem in America, and the opioid crisis continues to put a spotlight on it while the stakes grow. As we reported just before the holidays, the Centers for Disease Control released its most updated data on overdose deaths. The CDC confirmed that the situation is dire: overdose deaths reached a tragic new 12-month record, with over 100,000 American lives lost from April 2020 to April 2021. Media reports honed in quickly on the driver of this increase: opioids, specifically fentanyl, which killed 65% of those who died due to overdose.

Ahead of this report and because the opioid crisis isn’t new, those of us who track these issues could see a building response. The FDA recently approved a higher-dose version of naloxone, the opioid overdose reversal medication, in response to first responders who reported a growing need to administer multiple doses to revive people overdosing on fentanyl. Citing the threat of fentanyl, President Biden signed an executive order expanding sanctions against drug traffickers , part of ever-evolving strategies — involving administrations, lawmakers and law enforcement, and spanning many years — to crack down on the movement of opioids across our borders. And, we are now seeing more action at the federal, state, and local levels to increase access to not only prevention, treatment and recovery support, but also harm-reduction resources.

And yet, while fentanyl continues to kill people every day in record numbers, extraordinary and discriminatory policy barriers stand in the way of other efforts to help people — signs of the stigma that slows progress against the public health issue of addiction even in this state of emergency.

For example, while the federal government has taken steps to make harm-reduction resources more available, states like Florida and Wisconsin, among others, still consider test strips illegal drug paraphernalia, preventing their use as a tool to check illicit drugs for the presence of fentanyl so people can avoid unknowingly taking the deadly substance. That’s right — since last spring, federal dollars can be used to fund a proven harm-reduction tool that is against the law in several states.

A second example is that some substance use treatment providers are prohibited from testing patients on-site for the presence of fentanyl in their system — information that is essential to obtain in a timely fashion in order to effectively and safely initiate addiction-treatment medications. This is not a new problem; state leaders like Massachusetts Governor Charlie Baker called attention to it back in 2017.

Lawmakers and public officials at all levels of government should take note, particularly as they are now tasked with responsibly distributing billions of dollars in settlement funds related to the opioid epidemic.

Given the emergency nature of our growing fentanyl crisis, a quick and thorough audit of federal and state policies is needed to identify these and other opportunities to move beyond stigma, take action and save lives. The lives of hundreds of thousands of Americans with substance use disorders, their families, and our communities depend on it.

Emily Piper is the executive director of government relations and contracting for the Hazelden Betty Ford Foundation.