3 Things to Consider for International Overdose Awareness Day

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3 Things to Consider for International Overdose Awareness Day

By Jeremy Galloway 08/31/16

While 911 medical amnesty laws will encourage more people to report an overdose, certain demographic groups are hesitant to call because of fear that police might show up.

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August 31st is International Overdose Awareness Day. Like most people, I’d never heard of it—even after having used heroin for close to a decade—until an overdose death touched someone close to me. That was four years ago. My friend Nick’s death pushed me into the overdose prevention, harm reduction, and drug policy reform movements and I haven’t had a chance to catch my breath since.

My overdose prevention work has brought me into contact with people all over the spectrum, from high-ranking federal government officials to world-renowned addiction professionals, to top-notch public health experts. I’ve been privileged to have that opportunity, even if it did take something awful to set the wheels in motion.

Today is an anniversary of sorts for me, and as such I find it’s a useful time for reflection. With that in mind, here are three things to consider about overdoses and drug-related issues as we move forward into another year. Many thanks to the Australian founders of International Overdose Awareness Day, which is now observed in at least 11 countries, with dozens of events scheduled around the world.

1. Overdose deaths are a major public health problem, but how big of a problem is it?

There’s no doubt that heroin overdose deaths are rising. There were recently 174 overdoses in Cincinnati over a six day period. Before that there were 27 overdoses in Huntington, West Virginia (a town of 50,000 people) in a four hour period. Fortunately almost all these overdoses were reversed because of naloxone, the medication which reverses overdoses from opioids like heroin, hydrocodone, OxyContin, and fentanyl (along with its cousin carfentanil, an elephant tranquilizer, both of which have been responsible for many recent overdoses).

The number of heroin-related overdose deaths alone increased by 600% between 2001 and 2014. It’s a huge problem. But, as Fix columnist Zachary Siegel points out, it’s probably not so much that the rate of overdose deaths are rising as much as a shift in who is dying. The cases we hear about are younger, whiter, and typically come from more affluent families, characteristics which have contributed to fear campaigns from the media and politicians (like Maine Governor Paul LePage).

Stepping back to look at the big picture, while there are over 44,000 overdose deaths each year, fewer than one million Americans actually used heroin—even casually—in 2014. Yes, it matters when Johnny-football-hero falls victim to an overdose—but why do suburban white kids have to start dying for us to take notice?

As I’ve pointed out in the past, this problem has impacted poor people and communities of color for decades, during which the de facto solutions have included incarceration and coerced ‘rehabilitation.’ We need to apply the same set of standards—and compassion—to everyone who uses drugs, regardless of race or class. The white ‘victim’ of the drug plague is a familiar drug policy narrative, dating back well over 100 years.

Race and drug policy are invariably intertwined in US history. It’s been this way since the dawn of prohibition and there are few, if any, indicators that this might change in the near future. One thing that does seem to be changing is the demographic of drug users who die by overdose.

While most first-time heroin users are young and white, the vast majority of people who die from drug overdoses in the US are over the age of 25. The media and prohibitionist “drug-free community” organizations fan the flames and badly skew the public perception of drug and overdose issues in the process. On the bright side, though, all people who use—or misuse—opioids are likely to benefit from naloxone access.

And while 911 medical amnesty laws will encourage more people to report an overdose, certain demographic groups are hesitant to call 911 for help out of fear that police might show up. Given the current racial tensions surrounding policing in the US, this shouldn’t be surprising. And we should hope that the folks out there screaming that “all lives matter” will jump to the front of the line to address those situations.

2. Opioid overdoses are a growing concern, but what about other substances?

There’s been widespread discussion in the drug policy reform, harm reduction, and public health communities about opioid overdoses. This talk has spilled over into the general public. But we still tend to overlook the fact that people overdose on other drugs in massive numbers.

According to the Centers for Disease Control (CDC), in 2014 there were approximately 8,000 deaths involving benzodiazepines (a fivefold increase from 2001) and about 5,500 cocaine-related deaths (a 42% increase from 2001). There was also an average of about 2,200 alcohol-related deaths, or six every day, between 2002-2012.

Make no mistake, heroin and other opioids are killing people and it’s a growing problem. But many of these deaths result from people mixing drugs, which increases the risk of overdose exponentially. And all street drugs share a common factor: they’re illegal, which makes them dangerous. Their supply is unregulated, leaving them at risk for poisoning (intentionally or not), and the dosages are unknown.

Heroin is the big news right now, and the squeaky wheel gets the grease. But more people are still dying by prescription opioids, which are regulated. This underscores the need for more education, not tighter restrictions on the medications. In fact, all tighter regulation and prohibition have done is lead to more crime, mass incarceration, massive numbers of overdose deaths, and millions of broken hearts.

3. Overdose deaths are a hot topic, but are there more pressing concerns?

I won’t argue that overdose deaths aren’t a huge concern. They are. It’s why I became involved with harm reduction work. But other factors—many life-threatening—which impact substance users often go unnoticed. If these issues do get attention, they play second fiddle to overdose prevention.

Hepatitis C (HCV) is a major public health concern. There are currently 3.2 million people in the US living with chronic HCV, but 4 out of 5 of them don’t know they’ve been exposed. That’s enormous considering that, if left untreated, HCV can often be fatal.

I contracted HCV during my years injecting heroin. I was fortunate to be in trials for the new life-saving replacements for interferon (which comes with a long list of nasty side effects). But those medications are prohibitively expensive and remain out of reach for many people. HIV is also still a problem, as evidenced by recent outbreaks in places like rural Indiana and Kentucky. It’s no coincidence that these outbreaks comes in areas which have seen a huge increase in IV heroin use.

These problems can be solved with adequate education and access to public health resources. Syringe exchange programs play a major role in reducing transmission of HCV and HIV. When conservative Southern states like North Carolina begin legalizing syringe exchange programs and a Republican-controlled Congress lifts a longtime ban on federal funding for such programs, it’s time the rest of us stand up and ask what role we can play in addressing these problems in our own communities.

International Overdose Awareness Day is a time for us to focus on the growing overdose problem, but it’s also an opportunity to draw attention to the other risks and complications which should be concerns for people who use these drugs.

Overdose awareness day—and overdose prevention work—can’t simply be about preventing overdose deaths. It can’t simply be reactive. We won’t put an end to people misusing opioids, even if that is a worthy goal. We can, however, put an end to the needless suffering that reinforces people’s reasons for using. We can also develop best practices that make drug use less dangerous and, just maybe, dig down to the roots and start talking about why people use drugs in the first place.

 

Jeremy is Harm Reduction Coordinator at Families for Sensible Drug Policy, Program Director at Southeast Harm Reduction Project, a co-founder of Georgia Overdose Prevention, and state-certified peer recovery specialist in Atlanta, Georgia. He writes and speaks about drug policy reform, harm reduction, and including voices of directly-impacted people in public policy and is an outspoken and unabashed medication-assisted treatment (MAT) patient.

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