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The writer is a contributing columnist, based in Chicago
For over 50 years, the US has waged a relentless “war on drugs.” However, overdose deaths are now at an all-time high, significantly impacting US life expectancy. According to the US Centers for Disease Control and Prevention, overdose deaths have increased sixfold since 1999, with 111,000 fatalities recorded in the year leading up to April 2023, based on provisional CDC data.
The risk of accidental opioid overdose now surpasses the likelihood of dying in a car accident, as reported by the US National Safety Council.
US states and cities are urgently seeking solutions to address this crisis and have been experimenting with various approaches. Emergency overdose boxes have appeared in local libraries and senior centers, while vending machines equipped with Narcan (a naloxone nasal spray that can counteract opioid overdose) are being installed in selected Chicago subway stations. Some local pharmacies have even started selling Narcan over the counter alongside Halloween candy and Covid tests.
Despite decades of experimentation, including initiatives such as clean-needle sites, drug courts, and decriminalization of small drug possessions, this menace continues to plague lives and society. In recent years, the crisis has been exacerbated by synthetic opioids like fentanyl, which are considerably more potent and dangerous than heroin. Although US state and local governments are expected to receive over $50 billion in opioid legal settlements from drug manufacturers and intermediaries over the next two decades, addiction experts remain uncertain about how most of that money will be utilized.
Alex Elswick, who experienced homelessness due to opioid addiction following wisdom teeth removal, recounts how his mother couldn’t obtain Narcan for him during his active addiction in 2012. Elswick, now celebrating ten years in recovery, reveals that he and his mother established the Kentucky non-profit organization Voices of Hope primarily to distribute Narcan. He expresses gratitude that mothers in similar situations can now purchase it at drugstores.
Nevertheless, addiction experts agree that the $44.99 price tag for two doses of the drug will make it unaffordable for the majority of those in need. Consequently, cities like Chicago are expanding programs to provide Narcan for free. Sarah Richardson, part of Chicago city’s substance use team, believes that making it available over the counter will alter the dialogue surrounding opioid use and contribute to destigmatization. She informs me that pharmacists in Illinois have been permitted to dispense Narcan without a doctor’s prescription since 2017, and many insurance companies cover the cost. However, having to approach the pharmacist still presents a barrier for many individuals.
Christopher Jones, director of the center for substance abuse prevention at the US Substance Abuse and Mental Health Services Administration, emphasizes the importance of naloxone in his daily life and advocates for emergency overdose kits to be as prevalent in public places as automated external defibrillators for heart attacks.
According to Jones, naloxone is just one aspect of solving the complex problem of opioid deaths, which also requires a holistic approach to address underlying mental health issues. SAMHSA recently stated that 94% of individuals with a substance abuse disorder in the US did not seek treatment, primarily because they did not desire it. Jones insists on the need to raise awareness.
Elswick and other members of the addiction treatment community believe that the focus should shift away from the traditional narrative of recovery based on abstinence, often through a 12-step program. Elswick explains that the goal of the harm reduction movement is to mitigate harm rather than reduce drug use. Strategies include the distribution of naloxone and clean needles. He asserts that people can recover from addiction through various methods.
While most people agree on the importance of wider distribution of life-saving overdose treatments, there is a lack of consensus on how to address the issue comprehensively. Those involved in the current American drug war are divided between those advocating for the incarceration of drug users, those promoting abstinence-based recovery, and those supporting harm reduction measures.
As the battle continues, the death toll continues to rise.
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