A critical juncture for the US opioid epidemic

 A critical juncture for the US opioid epidemic

A critical juncture for the US opioid epidemic


Now that the COVID-19 pandemic in the USA has abated, the extent of the opioid epidemic’s devastation is no longer concealed. Data issued on July 14 by the National Center for Health Statistics indicates that overdose deaths are increasing. Between December 2019 and December 2020, the USA pandemic’s peak year, nearly 93,000 Americans died from drug overdoses, a 294 percent increase over the previous 12 months. This amounts to around 255 overdose deaths each day; the current daily national COVID-19 death toll is nearly the same. In addition 2020 will see the largest yearly increase in overdose deaths (21 000) making it an imperative moment to reassess the strategy for addressing the opioid crisis.
 
Opioids have been connected to over 500,000 deaths since the mid-1990s. The economic slump, corporate greed, and shifting views on pain management have all contributed to this trend. Through years of aggressive and misleading marketing, Purdue Pharma created the illusion that opioids were risk-free, impacted medical education, and helped loosen legislation. Furthermore, the availability of cheaper illicit opioids, such as fentanyl and heroin, surged, outwitting state and local governments that lacked the funding. Federal response to the opioid epidemic was sluggish the US Department of Health and Human Services (DHHS) didn’t even formally recognize it until 2017.
 
The opioid problem hasn’t, however, spread unchecked. Prescription medication monitoring systems and increasing the availability of naloxone have been two successful state-level initiatives throughout the past ten years. Support for medication-assisted therapy in the prevention of overdoses and treatment of substance abuse has also increased. In April 2021, the DHHS reduced the scope of the so-called X-waiver, enabling more healthcare providers to prescribe buprenorphine for patients with opioid use disorder. But progress has been hampered by the stigma attached to addiction, strict legal requirements and doctors’ steadfast refusal to advocate for medication-assisted therapy.
 
For this reason it is hopeful that the Biden administration has nominated Rahul Gupta to head the Office of National Drug Control Policy.

The appointment of Gupta a former West Virginia health commissioner marks departure from the legal  law enforcement approaches to drug policy and a move toward a greater focus on addiction treatment and healthcare services.Gupta is first medical practitioner to hold the role if authenticated.

 
For his appointment this is a crucial time. Data from 2020 suggest that the COVID 19 pandemic has played a major role in the increase in overdose deaths connected to opioids. Although the precise mechanisms are unknown it is likely that interruptions in the availability of treatment services and limited access to harm reduction strategies, such as the closure of safe injection sites, have played a role. The data highlights important demographic information as well. West Virginia the state with the highest number of overdose deaths, continues to be the hub of the epidemic; nonetheless, metropolitan areas have outperformed rural areas in terms of age-adjusted mortality rates. 
The number of Black, non-Hispanic adults in urban areas who overdosed on synthetic opioids between the ages of 45 and 64 has been rising over time. COVID-19 is also a greater cause of death for this group. It would be naive and idiotic to believe that overdose fatalities are only the province of the old, especially when middle-aged persons are disproportionately white and rural and the opioid issue is still having a large impact on them. One of Gupta’s biggest challenges will be to increase the funding for addiction prevention and treatment programs within the occasionally fragmented public health insurance-funded infrastructure. He will have to equitably target recently emerging opioid-related regional and social vulnerabilities and increase resources in the COVID-19-affected areas.

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