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A Call To Bolster Public Health Approach To Overdose Crisis

In the 1970s, when soldiers returning from Vietnam were grappling with heroin addiction, the first U.S. drug czar developed a national system of clinics that offered not only methadone but also counseling, 12-step programs and social services. Roughly 70 percent of the federal drug control budget was devoted to this initiative, but it was short lived. Mired in controversy and wanting to appear tough on crime, President Nixon tacked right a few months before resigning, and nearly every president after him followed the course he set. Before long, the funding ratio between public health and criminal justice measures flipped. Police and prison budgets soared, and anything related to health, medicine or social services was largely ignored. The results are clear: Drug use is soaring. More Americans are dying of overdoses than at any point in modern history. It’s time to reverse course, the New York Times says in an editorial. Drug use and addiction are as old as humanity itself, and historians and policymakers likely will debate whether the war on drugs was ever winnable, or what its true aims were. In the meantime, it’s clear that to exit the current morass, Americans will have to restore public health to the center of its approach, the newspaper says.

The Biden administration has taken some steps. In 2021, the Office of National Drug Control Policy began spending slightly more money on treatment and prevention than on law enforcement and interdiction, for the first time in a generation. The Department of Health and Human Services is granting waivers to states that want to activate Medicaid for inmates before they are released from prison. The Labor Department is enforcing laws that require health insurance providers to cover addiction treatment at the same level that they cover other types of care. Laws are changing. Doctors who want to treat opioid addiction with medications like buprenorphine no longer must get a waiver from the Drug Enforcement Administration. Lawmakers are pushing for naloxone, the overdose reversal medication, to be sold over the counter. Other ideas include amending outdated policies like the "crack house statute." This federal law subjects anyone to steep penalties, if they maintain a building for the purpose of using illicit drugs. It was enacted at the height of the crack epidemic but is now being used to stymie supervised consumption sites, which are fundamentally different from crack houses. Investing in treatment would also help end the war on the drugs because there are not enough programs or professionals to treat substance-abuse disorders. People cannot heal from, or live stably with, substance-use disorders if they lack proper housing or suffer from untreated trauma or mental illness, so root causes need to be addressed. For harm reduction, or any attempt to address the overdose epidemic, to succeed, communities will need to create more housing options.


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