By German Lopez
December 21, 2017
Source: VOX
Photo / Image Source: Unsplash,
Fentanyl will require unique solutions
The balloon effect doesn’t necessarily mean that the crackdown on opioid painkillers was a mistake. It appeared to slow the rising number of painkiller deaths, and it may have prevented doctors from prescribing the drugs — or letting them proliferate — to new generations of people who’d develop drug use disorders. So, the crackdown did lead to more heroin and fentanyl deaths, but it will hopefully prevent future populations of people with addiction, who could have suffered even more overdose deaths.
The balloon effect also doesn’t mean that going after supply is entirely useless; there are some supply enforcement efforts that could help. For example, starting March 1, China banned the manufacture and sale of fentanyl and some of its analogs, including carfentanil. It remains to be seen what kind of effect this will have — in the past, China has struggled to actually shut down the many clandestine drug labs within its borders even after banning their products. But the DEA called the newest fentanyl ban a “game changer.”
Still, the fundamental solution needs to be reducing the existing demand for opioids — so that people don’t seek out dangerous drugs like heroin or fentanyl in the first place. To put it simply: While a crackdown on supply might stop future generations of drug users, it doesn’t do much for the current generation of drug users who are addicted and want these drugs. That’s where treatment can come in to help people quit their addictions.
There has been some movement in that direction, such as when Congress in 2016 approved $1 billion over two years for drug addiction treatment.
But drug policy experts widely agree that much more money will need to be put toward addiction treatment. After all, a 2016 report from the US surgeon general found that only 10 percent of people with a drug use disorder get specialty treatment — in large part because there is a huge shortage of accessible and affordable options. Some experts estimate it will take tens of billions dollars a year to remedy this gap.
Beyond raw funding for treatment, some drug policy experts would also like to see a change in how treatment is done.
For some people, lifelong drug use is likely a reality. The best treatments for opioid addiction — meaning medication-assisted treatment, which pairs therapy with medicine like buprenorphine and methadone — only work for about 60 percent of users. That’s a lot of patients who can’t be reached by the gold standard of care, and will continue to use (and die) as a result.
So some experts have pushed for actually supplying pure heroin in supervised injection facilities. The thinking is simple: At the very least, drug users will know these drugs are not laced with fentanyl or its analogs. If they do overdose, staff will be standing by to apply naloxone or oxygen to prevent death. And while users are at these facilities, they can be linked to treatment to, perhaps, slowly get off the heroin.
As Maryland-based drug policy experts Bryce Pardo and Peter Reuter wrote in an editorial in the Baltimore Sun, “Heroin-assisted therapy addresses the immediate overdose threat posed by fentanyl — something naloxone attempts to do after the fact. Prescribed heroin use in a clinical and supervised setting ensures that users are not consuming fentanyl and that staff are on hand should something go wrong.”
This isn’t just the stuff of wonks’ imaginations. It’s now done in multiple countries, from Canada to Switzerland.
And here’s the important thing: It really works. Researchers credit the European prescription heroin programs with better health outcomes, reductions in drug-related crimes, and improvements in social functioning, such as stabilized housing and employment. Canadian studies also deemed prescription heroin effective for treating heavy heroin users. A review of the research — which included randomized controlled trials from Switzerland, the Netherlands, Spain, Germany, Canada, and the UK — reached similar conclusions, noting sharp drops in street heroin use among people in the treatment.
Now, this treatment is likely only going to be needed for a small fraction of opioid users. When I visited the prescription heroin clinic in Vancouver, Canada, staff there estimated that about 10 to 15 percent of people addicted to opioids will need the treatment they provide.
But the expanding opioid epidemic shows why it might be necessary. Going after the supply of opioids has led to the supply getting more dangerous, emphasizing the need for more action on the demand side. Medication-assisted treatment is great, but it and other more conventional forms of treatment don’t work for everyone. So as addiction treatment scales up, it might be a good idea to take some newer harm reduction steps that also try to mitigate the dangers of the illicit opioid supply.
Heroin-assisted treatment also shows the need to be creative with the current drug crisis. It’s definitely not an idea that US policymakers or the public will be accustomed to. But it works for some patients.
How can such practices impact your health? Why? What is your experience?
Share the wealth of health with your friends and family by sharing this article with 3 people today.
If this article was helpful to you, donate to the Shidonna Raven Garden and Cook E-Magazine Today. Thank you in advance.
Comments