IT IS MY HOPE that one day this public health crisis will be nothing but a memory. It has sickened and killed far too many, torn families apart, and weakened communities.
I write not about the COVID-19 pandemic – I hope that becomes a memory, too – but of the opioid overdose epidemic that has persisted throughout it.
To provide some context, progress on the opioid overdose crisis over these last five years since the creation of RIZE Massachusetts Foundation – an act of immense commitment on the part of the state’s business community and sustained by public sector investments – has benefitted from: new laws and regulations designed to address root causes; increased access to lifesaving treatments, including medication for opioid use disorder and naloxone to reverse overdoses; and a better understanding of the disease of addiction and evidence-based treatments.
This progress should not create misperceptions, however. Plenty of work remains.
The rate of death from overdose, which first shocked Massachusetts communities and policy makers into action, has remained stubbornly high over five years at about 2,000 cases per year. This rate has remained level across the board, but, tragically, Black men have seen more fatal overdoses in recent years.
While there are fewer prescription drugs like oxycodone circulating than before, there has been a sharp increase in street drugs like heroin, which is almost always laced with fentanyl, a synthetic opioid present in most fatal overdoses. Fentanyl is very cheap to make, difficult to detect, and easy to transport. We’re now also facing the concerning trend of an increase in stimulant use which requires a different set of interventions than opioid use.
The one overarching lesson from our work is that people with opioid use disorder (OUD) can recover. OUD is not a dead end and it is not a death sentence. Recovery is not easy, either. And we should do more to tell the success stories of those who have made it.
The stigma around addiction makes the prospect of recovery harder. It devalues and dehumanizes and tends to overlook one very simple fact: Anyone can become addicted. People from all walks of life struggle with addiction: the rich and the poor, and everyone in between; the most accomplished professionals and those with few skills; people living in the inner-city and those in a hill town in the Berkshires; and people of every race.
Eliminating stigma is critical to eliminating overdose deaths.
For those in the grip of OUD, harm reduction to prevent overdoses and improve health is essential. This includes services that some might be uncomfortable with, such as syringe exchanges and safer smoking kits.
For people with OUD experiencing homelessness, we have learned that new approaches can work and are needed at a greater level across the state. The removal of encampments at the “Mass. and Cass” area of Boston has demonstrated the effectiveness of providing one-to-one support and assistance as well as creating low-threshold housing enriched with services. The Wu administration should be commended for its public health-centered approach, as should the frontline health workers who have made that approach work.
The opioid crisis did not happen overnight; it resulted from a complex set of circumstances. The teamwork and collaboration that we have been part of over the last five years may be one of the great public-private partnerships over the last several decades. Most notably, we work very closely with community leaders and people on the front lines, including those with lived experience. People closest to the problem often have the best solutions – yet they are often farthest away from where the decisions are made. RIZE has been working to change that.
Some of the things that we have been able to accomplish include: growing the behavioral health workforce to provide more interculturally responsive treatment; supporting mobile outreach and harm reduction to provide care where the people who need it are, while training social work students to deliver these services; funding addiction treatment programs for BIPOC who have been less likely to receive services; and supplying critical rapid response grants that enabled providers to continue to care for patients even in the early days of the COVID-19 pandemic, so as to prevent backsliding on progress.
We will continue to convene stakeholders so that we may learn from one another, evaluate successes and failures, and find ways to innovate so that we truly can eliminate stigma and overdose deaths.
Much has been done – yet much work remains. The solution to this crisis will require the continuation of a coordinated and concerted effort of policy makers, public health leaders, the business community, and the public.