Why are overdose deaths still so high?
A difficult but important year-end question
By Jeremiah Gardner
NOTE: This was originally published for the Hazelden Betty Ford Foundation’s monthly Recovery Advocacy Update. If you’d like to receive our advocacy emails, subscribe today.
The public commitment to addressing addiction — and general awareness of the issue — is so much greater today than when I started working at Hazelden Betty Ford a decade ago that it’s almost hard to remember how niche our issue once seemed. These days, instead of thinking legislation like the Restoring Hope in Mental Health and Well-being Act is a pipe dream, we know it’s in the mix as Congress negotiates its end-of-session spending package (call your Members of Congress and urge support!).
Still, after years of attention and action on a potpourri of solutions, we continue to see:
- record-high overdose deaths (two-thirds due to fentanyl);
- increased deaths among many populations (including, as new data show, older adults and pregnant and postpartum women);
- and on top of it all, escalating deaths related to alcohol, too.
Why? That’s the question many are now asking, and that even more will ask in the coming year.
Hazelden Betty Ford President and CEO Dr. Joseph Lee went on MSNBC’s Morning Joe to discuss fentanyl this week. His conversation with national journalists came in the wake of a new investigative piece by the Washington Post, which takes aim at federal policymakers, highlighting many issues but first and foremost a perceived failure over several years to keep illicit fentanyl out of the country.
The Post’s story was an interesting take, given that some recovery advocates are saying almost the opposite — that the intractability of the overdose epidemic is due to policymakers and law enforcement agencies having already reignited a new, counterproductive war on drugs — one focused first on demonizing pain pills, then heroin and now fentanyl.
There is likely some truth and learnings in both competing assessments, but each also seems incomplete. For example, if you deem any one solution from recent years as ineffective due to overdoses persisting (i.e. efforts to limit excessive prescriptions and then interrupt the flow of heroin and fentanyl), you can also, by the same logic, deem every other solution ineffective. If overdose deaths have continued to climb despite the widespread proliferation of the overdose reversal medication naloxone and treatment medications like buprenorphine, does that mean they are failed solutions? How about all the new investments in recovery supports and harm reduction, or treatment —are they also failed solutions?
Perhaps they’re all helpful, even if something is still missing. Maybe they prevented us from experiencing even more deaths and we need more of the same. Or maybe we just need a more effective combination of solutions — a little more of this and a little less of that. Those explanations — vague as they may be — are certainly more satisfying to our common sense. Most of us know intuitively and from firsthand experience that everything helps someone.
Does treatment, including medications, help? Of course. Keeping people alive with naloxone? For sure. Do robust recovery communities help people initiate and/or sustain recovery? Absolutely. Do we need to disrupt the supply chain that has created the most lethal drug supply in history? Seems like a no-brainer (if our food supply were poisoned, we’d disrupt that without thinking twice). So, once again, why are overdoses still so high?
I certainly haven’t cracked the code myself. We’re all learning and searching together. What I can say is that as I’ve been reflecting, I’ve thought a lot about my mom, who experienced a severe substance use disorder and co-occurring physical and mental health conditions. She overdosed in 2015 on prescription medications including opioids. In a talk I gave just three months following her death, I included this rather instinctual assessment: “What my mom needed was a good year or more of integrated care and checkups — surrounded by support.”
Reviewing that now, I realize that despite the potpourri of solutions put forward these past seven years or so, the nation hasn’t moved the needle much on what I thought my mom needed most —and what I think a lot of family members want for their loved one who has a severe substance use disorder: comprehensive long-term care and support.
Insurance generally isn’t covering longer care. Long-term recovery supports are growing but not funded (other than by tenuous grants) and most are not part of, or coordinated with, the addiction care system. Furthermore, integrated mental health, substance use and primary care remains mostly a dream. Primary care doesn’t have the knowledge or resources to do more, nor the financial incentives to change. And most behavioral health care providers don’t have the margins (aka, reimbursement rates) to properly staff for integrated care. Underlying all of these roadblocks is a lack of systemic resource allocation: an unreadiness to acknowledge that a better addiction care system will cost significantly more — and an inability among those of us working in this scarcely resourced space to demonstrate a public case compelling enough to overcome the stigma that inhibits the sea change so clearly needed.
Until addiction care is on par with care for other health care conditions — meaning we invest enough as a system and society to provide sufficient care and long-term support to all who need it — we ought to make sure we’re prioritizing measures, solutions and efforts that move us in that direction.
Thank you for reading and for your own advocacy in 2022. I’m interested in your thoughts on this year-end question of why overdoses continue to be at record highs despite several years of advocacy and action. Please leave a comment and enjoy a fantastic transition to the new year!
Jeremiah Gardner is director of communications and public affairs for the nonprofit Hazelden Betty Ford Foundation.
