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The State of Opioids

A Crisis with No End in Sight

The United States continues to be in the grips of a surging drug overdose crisis driven largely by opioids. In August 2017, the Centers for Disease Control and Prevention released new data reporting that more than 64,000 Americans died of drug overdose deaths in 2016—a 21 percent increase from 2015.Centers for Disease Control and Prevention (CDC), “Provisional Counts of Drug Overdose Deaths, as of 8/6/2017,” Drug overdose death rates have increased significantly since the 1980s, and the enormity of the crisis across geographic, economic, and racial boundaries has prompted calls from multiple sectors to develop a comprehensive approach to the problem.Josh Katz, “Drug Deaths in America Are Rising Faster than Ever,” New York Times, June 5, 2017.

The year saw intensified efforts at the federal, state, and local levels to develop such an approach, but myriad challenges remain. On October 26, 2017, President Trump declared the opioid crisis a national “public health emergency,” bringing increased attention to the epidemic but falling short of his promise to declare the “national emergency” that would have triggered rapid allocation of funding.Presidential Memorandum for the Heads of Executive Departments and Agencies, “Combatting the National Drug Demand and Opioid Crisis,” October 26, 2017; and Julie Hirschfeld Davis, “Trump Declares Opioid Crisis a ‘Health Emergency’ but Requests No Funds,” New York Times, October 26, 2017. Six days later, the President’s Commission on Combating Drug Addiction and the Opioid Crisis released its final set of recommendations, but left open the question of how much it would cost to fund implementation.The President’s Commission on Combating Drug Addiction and the Opioid Crisis (The President’s Opioid Commission), The President’s Commission on Combating Drug Addiction and the Opioid Crisis: Final Report (Washington, DC: The President’s Opioid Commission, 2017). Progress has been made: in the past few years, states have expanded naloxone access and passed Good Samaritan laws, and many criminal justice professionals are moving away from approaches that criminalize drug use in favor of incorporating principles of harm reduction.The President’s Opioid Commission, Final Report (2017), at 11-13, 17-18; and The Network for Public Health Law, Legal Interventions to Reduce Overdose Mortality: Naloxone Access and Overdose Good Samaritan Laws, 2, (Edina, MN: Network for Public Health Law, 2017). Against this background, renewed debates have emerged about the relationship between drug use and other crimes (such as theft), the appropriateness of using the criminal justice system to respond to people who use drugs, and what constitutes the most effective set of interventions to curb the rising tide of death. Without contesting that treating addiction as a public health issue is the right approach, critics have also pointed out the discrimination inherent in the more sympathetic response emerging for an epidemic that has primarily impacted white communities, in contrast to the criminal justice response employed during the crack cocaine epidemic, which primarily affected communities of color.Carl L. Hart, “The Real Opioid Emergency,” New York Times, August 18, 2017; and German Lopez, “When A Drug Epidemic’s Victims are White: How Racial Bias and Segregation Molded a Gentler Rhetorical Response to the Opioid Crisis,” Vox, April 4, 2017.

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  • Sharon Stancliff, MD
  • Dionna King
  • Jonathan Giftos, MD, AAHIVS