by Kristen Fuller, MD | ❘
According to the National Institute on Drug Abuse (NIDA), 108,000 people in the U.S. died from a drug-involved overdose in 2022, including from illicit or prescription drugs. This harrowing statistic, tied with the current fentanyl crisis, prompted a key question during the first presidential debate of 2024: “What are you going to do to help Americans in the throes of addiction right now who are struggling to get the treatment they need?”
Unfortunately, both front-runner presidential candidates, former President Donald Trump and current President Joe Biden, missed the mark as they did not directly answer the question and, more importantly, did not once mention “treatment.” Instead, the two made the question into a border security issue instead of a human crisis. Both candidates listed addiction-related buzzwords, like female drug mules, drugs and border security, drug-sniffing dogs, and fentanyl-detection machines, instead of explaining a plan to help Americans receive life-saving treatment.
More Americans than ever are dying from drug overdoses, primarily fentanyl-related overdoses, as the opioid epidemic continues to crash through communities in nearly every corner of the country. This crisis is not about our borders; it’s about providing people with the treatment they need to overcome addiction.
Fentanyl and other dangerous drugs have been within our borders for decades, yet we are still at a loss for how to help Americans get the treatment they need for their addiction. We are failing to address this crisis by not providing tangible treatment solutions, public education, awareness campaigns, and reducing the stigma surrounding addiction.
Are our borders a concern when it comes to addiction in the United States? Maybe. However, the “border problem” mentioned by both Donald Trump and Joe Biden does not address addiction treatment. Rather, it serves as a red herring to allow both candidates to refocus the issue on immigration.
Drug addiction hits close to home for hundreds of thousands, if not millions, of Americans, including President Joe Biden and his family. President Biden did not mention his son Hunter’s public struggle with drug addiction when asked about his plan for helping other Americans who live with addiction. What could have been an opportunity to reduce the stigma of addiction and offer other families hope, was unfortunately used as a segway to address border security.
Former President Trump tried to blame the rise in deadly overdoses on the COVID-19 pandemic and argued that overdose deaths decreased before COVID. While attempting to address the question posed by debate moderator Jake Tapper, the former president said, “We were doing very well on addiction until the COVID came along … we had two and a half, almost three years of like nobody’s ever had before any country in every way.”
Trump was most likely trying to reference the fact that opioid overdose death rates slowed slightly between 2017 and 2019; however, they were still trending upwards overall from 1999 and then drastically increased from 2019 to 2022. The former president didn’t provide any information regarding policies or initiatives he or his administration implemented in those years, failing to support his claim that the decrease in overdose deaths was in any way attributable to him.
The rising use of fentanyl, both intentionally and unintentionally, has been the primary driving force behind the current wave of America’s opioid crisis. Overdose deaths skyrocketed in 2021 and continued to do so into 2022. During these years, the country saw more than 100,000 fatal drug overdoses, with 70% of those deaths involving synthetic opioids like fentanyl.
Illicitly made fentanyl is commonly mixed with other illegal drugs, such as cocaine, methamphetamines, xylazine, counterfeit pills, MDMA, and heroin. Drug dealers are increasingly adding fentanyl to street drugs because it is inexpensive, and consuming a small amount produces an intense high.
The problem with fentanyl, besides it being incredibly lethal, is that it has no taste or smell, and someone using drugs may not know that their drugs are laced with fentanyl. Just 2 milligrams of fentanyl can be deadly depending on a person’s body weight, tolerance, and prior usage. The DEA found that 42% of seized pills tested for fentanyl contained a potentially lethal dose.
Although COVID-19 did exacerbate the opioid crisis from 2019 to 2022 and escalated overdose deaths in a myriad of ways, the opioid crisis has been on the rise long before the COVID-19 pandemic.
Eliminating all illegal drugs smuggled into the US would be a great triumph, but it does not answer the question of “What are you going to do to help Americans with an addiction get the treatment they need?”
Americans with addiction are not just using opioids. Almost 180,000 Americans die from excessive alcohol use each year. Others with a mild substance use disorder are now at risk of death because of fentanyl laced drugs, even if they think they are taking something they consider low risk.
Increasing access to addiction treatment, providing financial assistance for rehab, enacting harm reduction strategies, and providing public education are just a few ways that we can help Americans in need.
Harm reduction is an addiction treatment strategy that addresses fentanyl-laced drugs. It is an evidence-based addiction treatment approach that is focused on engaging with people who use drugs and equipping them with life-saving tools and information to help them stay safe while using drugs.
Abstinence in the addiction treatment world is not always practical, nor is it always the safest route to become substance-free, so other treatment approaches, such as harm reduction programs, are often practiced within addiction treatment centers alongside traditional approaches like medication and therapy. Examples of opioid harm reduction strategies include:
Naloxone is a life-saving medication that rapidly reverses an opioid overdose. It can be purchased over the counter, is often free at community center addiction programs, and should be administered to anyone suspected of an opioid overdose. Fentanyl test strips are small strips that can be placed within a personal sample of a drug supply to detect the presence of fentanyl. The thought behind test strips is that if someone is going to use cocaine or heroin, they should be equipped with tools that keep them as safe as possible, similar to the needle exchange programs that were introduced in the 1980s to prevent blood-borne infectious diseases from needle sharing with IV drugs such as heroin.
The Biden-Harris administration has made tremendous strides in harm reduction programs in the U.S., resulting in significant advancements in overdose prevention strategies. The Biden-Harris administration significantly increased access to buprenorphine, methadone, and naloxone, all life-saving medications used to treat opioid addiction. The administration also approved federal grant funds to be used to purchase xylazine test strips. Like fentanyl test strips, xylazine test strips can detect the presence of xylazine that has been laced into illicit drugs and is associated with significant and rapidly worsening negative health consequences. None of these strides were mentioned in the debate; an unfortunate missed opportunity to educate the American people on strategies that save lives.
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Harm reduction programs have been massively successful at preventing overdose deaths and urging people to seek treatment but are often considered controversial. One harm reduction program that is having trouble getting off the ground due to lawmakers and politics is overdose prevention centers.
Overdose prevention centers could have been discussed during the presidential debate instead of blaming addiction on the borders, as both presidential candidates played a hand in preventing these “safe houses” from getting off the ground. Overdose prevention centers (OPC), sometimes called “safe consumption” or “supervised injection” sites, allow people to use their drugs under the supervision of people trained to intervene with naloxone if they overdose.
According to the Drug Policy Alliance, OPCs help bring public drug use indoors and off the streets. Participants bring their own drugs, and trained staff provide sterile supplies and intervene if an overdose occurs. OPCs connect people with addiction services and social supports, including voluntary treatment. Nearly 200 overdose prevention sites operate in 14 countries. Unfortunately, there are only two ODCs in the U.S., both located in New York City. To date, no deaths have been reported at either OPC in New York.
OPCs have been found to be associated with reduced overdose deaths, substance use–related harms, and all-cause mortality among people who use drugs and to be cost-effective.
Perhaps the largest barrier faced by many who struggle with addiction is the cost of treatment. According to the National Council for Mental Wellbeing, 43% of U.S. adults who say they needed substance use or mental health care in the past 12 months did not receive that care. Of those who needed help but did not receive it, a staggering 37% said that cost-related issues (no insurance or inability to cover costs) kept them from receiving care.
If we zoom out to include healthcare as a whole, over half of the U.S. population say they have difficulty affording healthcare costs, and nearly 61% of uninsured adults say they went without needed care because of the cost. The U.S. is currently one of only two OECD nations (out of 38 countries) that does not offer a form of universal or nationalized healthcare, the other being Mexico. Despite this, the U.S. not only spends nearly twice as much as the next-highest country on healthcare costs, but also the has the highest rates of deaths from avoidable or treatable causes, the lowest life expectancy at birth, the highest suicide rate, and the highest maternal and infant death rates.
Subsidizing addiction treatment care to make it affordable and accessible would save thousands of lives and provide Americans with the ability to overcome addiction and get their lives back on track.
Harm reduction is not the only addiction treatment strategy that could have been discussed during the presidential debate. Other essential topics pertaining to addiction treatment that should be up for discussion and debate include:
The opioid crisis and addiction in our country are not going away until we figure out a way to provide compassionate, affordable, and realistic multifaceted prevention and treatment strategies. This is not a “border issue” but a human crisis that is knocking on our front doors, sitting at our dinner tables, taking lives, and tearing apart families.
It can be difficult to focus our attention on addiction treatment in a time when our elected officials point the focus towards issues like border security instead of tangible treatment efforts. Fortunately, there are people who can help you or loved one start that journey. While there is still much work that needs to be done in the fight against the opioid epidemic and addiction, treatment is available. To learn more about treatment options available to you, contact a treatment provider today for free.
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Kristen Fuller, MD
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