Jeneen Interlandi

More people are dying of drug overdoses in the United States today than at any point in modern history. The overdose fatality rate surpassed 100,000 per year for the first time ever in 2021. Halfway through 2022, it appears to be rising even further (the latest numbers come out to about 300 people per day, or 12 people every hour, on average). It’s tempting to see this crisis as the unavoidable byproduct of an unprecedented moment. Breathtaking drug industry malfeasance, soaring economic inequality and a world-shaking pandemic have conspired in ways that can make these kinds of deaths seem all but inevitable, and it’s easy to imagine that such a wretched trifecta could not possibly have been anticipated, let alone prevented. But addiction itself is as enduring a part of the human experience as cancer, diabetes or Alzheimer’s. In fact, it is at least as common as any of those. And our failure to treat it as consistently or as rigorously is not an accident. It is a choice.

3 thoughts on “Jeneen Interlandi

  1. shinichi Post author

    12 Americans Die of an Overdose Every Hour. We Have the Knowledge to Prevent That.

    by Jeneen Interlandi

    June 24, 2022

    https://www.nytimes.com/2022/06/24/opinion/addiction-overdose-mental-health.html

    More people are dying of drug overdoses in the United States today than at any point in modern history. The overdose fatality rate surpassed 100,000 per year for the first time ever in 2021. Halfway through 2022, it appears to be rising even further (the latest numbers come out to about 300 people per day, or 12 people every hour, on average). It’s tempting to see this crisis as the unavoidable byproduct of an unprecedented moment. Breathtaking drug industry malfeasance, soaring economic inequality and a world-shaking pandemic have conspired in ways that can make these kinds of deaths seem all but inevitable, and it’s easy to imagine that such a wretched trifecta could not possibly have been anticipated, let alone prevented. But addiction itself is as enduring a part of the human experience as cancer, diabetes or Alzheimer’s. In fact, it is at least as common as any of those. And our failure to treat it as consistently or as rigorously is not an accident. It is a choice.

    In some ways, it’s a choice we made decades back. By the time the American Medical Association recognized alcoholism as an illness in 1956, three deep fissures had already been carved between addiction, mental illness and virtually all other forms of sickness. Most health conditions were treated by medical doctors who were funded through health insurance, bound by a raft of regulations and held to strict professional standards. Mental illness was separate: accepted as a subset of mainstream medicine, but treated in separate facilities and not fully covered by insurance.

    And addiction was something else entirely. Despite the A.M.A.’s pronouncements, most people continued to view it as a failure of morals or of willpower, a problem to be worked out with one’s priest or probation officer. Addiction psychiatry became a distinct subspecialty only in 1993. Despite being one of the most common conditions listed in the Diagnostic and Statistical Manual of Mental Disorders (psychiatry’s bible), few psychiatrists have been adequately trained to treat it. “It’s been sort of orphaned,” said Dr. Mishka Terplan, a psychiatrist and medical director of the nonprofit Friends Research Institute. “It still receives only a small fraction of the attention or resources that we devote to other common psychiatric disorders. And what it does get comes through completely different mechanisms.”

    Basic science and decades of failed policy have long since made clear that addiction is a legitimate medical condition — a chronic relapsing brain disorder, to be precise — and that it’s often triggered (or exacerbated) by mental illness or by social forces like poverty and childhood trauma. But the systems by which this disorder is treated have yet to shift accordingly.

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  2. shinichi Post author

    Overdose Deaths Reached Record High as the Pandemic Spread

    More than 100,000 Americans died from drug overdoses in the yearlong period ending in April, government researchers said.

    by Roni Caryn Rabin

    Nov. 17, 2021

    https://www.nytimes.com/2021/11/17/health/drug-overdoses-fentanyl-deaths.html

    Americans died of drug overdoses in record numbers as the pandemic spread across the country, federal researchers reported on Wednesday, the result of lost access to treatment, rising mental health problems and wider availability of dangerously potent street drugs.

    In the 12-month period that ended in April, more than 100,000 Americans died of overdoses, up almost 30 percent from the 78,000 deaths in the prior year, according to provisional figures from the National Center for Health Statistics. The figure marks the first time the number of overdose deaths in the United States has exceeded 100,000 a year, more than the toll of car crashes and gun fatalities combined. Overdose deaths have more than doubled since 2015.

    Administration officials said on Wednesday that they will expand access to medications like naloxone, which can reverse an opioid overdose, by encouraging states to pass laws that will make it more widely available and promoting its use by Americans.

    “I believe that no one should die of an overdose simply because they didn’t have access to naloxone,” said Dr. Rahul Gupta, director of the Office of National Drug Control Policy. “Sadly, today that is happening across the country, and access to naloxone often depends a great deal on where you live.”

    Though recent figures through September suggest the overdose death rate may have slowed, the grim tally signals a public health crisis whose magnitude was both obscured by the Covid pandemic and accelerated by it, experts said.

    “These are numbers we have never seen before,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. The fatalities have lasting repercussions, since most of them occurred among people aged 25 to 55, in the prime of life, she added.

    “They leave behind friends, family and children, if they have children, so there are a lot of downstream consequences,” Dr. Volkow said. “This is a major challenge to our society.”

    The rise in deaths — the vast majority caused by synthetic opioids — was fueled by widespread use of fentanyl, a fast-acting drug that is 100 times as powerful as morphine. Increasingly fentanyl is added surreptitiously to other illegally manufactured drugs to enhance their potency.

    Overdose deaths related to use of stimulants like methamphetamine, cocaine, and natural and semi-synthetic opioids, such as prescription pain medication, also increased during the 12-month period.

    While some drug users seek out fentanyl, Dr. Volkow said, others “may not have wanted to take it. But that is what is being sold, and the risk of overdose is very high.”

    “Many people are dying without knowing what they are ingesting,” she added.

    People struggling with addiction and those in recovery are prone to relapse, Dr. Volkow noted. The initial pandemic lockdowns and subsequent fraying of social networks, along with the rise in mental health disorders like anxiety and depression, helped create the crisis.

    So, too, did the postponement of treatment for substance abuse disorders, as health care providers nationwide struggled to tend to huge numbers of coronavirus patients and postponed other services.

    Dr. Joseph Lee, president and chief executive of the Hazelden Betty Ford Foundation, said that community and social support that was lost during the pandemic, along with the closing of schools, contributed to the death toll. “We’re seeing a lot of people who delayed getting help, and who seem to be more sick,” Dr. Lee said.

    The vast majority of these deaths, about 70 percent, were among men between the ages of 25 and 54. And while the opioid crisis has been characterized as one primarily impacting white Americans, a growing number of Black Americans have been affected as well.

    There were regional variations in the death counts, with the largest year-over-year increases — exceeding 50 percent — in California, Tennessee, Louisiana, Mississippi, West Virginia and Kentucky. Vermont’s toll was small, but increased by 85 percent during the reporting period.

    Increases of about 40 percent or greater were seen in Washington State, Oregon, Nevada, Colorado, Minnesota, Alaska, Nebraska, Virginia and the Carolinas. Deaths actually dropped in New Hampshire, New Jersey and South Dakota.

    “If we had talked a year ago, I would have told you deaths are skyrocketing. But I would not have guessed it would get to this,” said Dr. Andrew Kolodny, medical director of the Opioid Policy Research Collaborative at Brandeis University’s Heller School for Social Policy and Management.

    Most of those who died probably already suffered from addiction, or were in recovery and relapsed, an ever-present risk exacerbated during times of stress and isolation, Dr. Kolodny said.

    Many of those with an addiction to synthetic opioids very likely became addicted after being given prescription opioids by medical providers. “Teenagers are routinely being given opioids to this day when their wisdom teeth come out,” he said.

    The vast stimulus bill passed last spring included $1.5 billion for the prevention and treatment of substance use disorders, and $30 million to fund local services for people struggling with addiction, including syringe exchange programs.

    Federal funds can also be used now to buy rapid test strips to detect whether illicit drugs have been laced with fentanyl.

    But critics say the federal response has been inadequate, given the magnitude of the public health emergency. They have called for new funding to provide universal access to treatment, and for treatment centers in every county that offer same-day access.

    For example, physicians still need federal permission to prescribe buprenorphine, a first-line treatment for opioid use disorder, which limits the number of providers.

    “If you really want to see deaths comes down, you have to make it much easier for someone who is addicted to opioids to access treatment, particularly with buprenorphine,” Dr. Kolodny said.

    “It has to be easier to get treatment than to buy a bag of dope.”

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  3. shinichi Post author

    Overdose Deaths Continue Rising, With Fentanyl and Meth Key Culprits

    New data shows a surge in overdose deaths involving fentanyl and methamphetamine. Overall, the nation saw a 15 percent increase in deaths from overdoses in 2021.

    by Noah Weiland and Margot Sanger-Katz

    May 11, 2022

    https://www.nytimes.com/2022/05/11/us/politics/overdose-deaths-fentanyl-meth.html?referringSource=articleShare

    WASHINGTON — After a catastrophic increase in 2020, deaths from drug overdoses rose again to record-breaking levels in 2021, nearing 108,000, the result of an ever-worsening fentanyl crisis, according to preliminary new data published on Wednesday by the Centers for Disease Control and Prevention.

    The increase of nearly 15 percent followed a much steeper rise of almost 30 percent in 2020, an unrelenting crisis that has consumed federal and state drug policy officials. Since the 1970s, the number of drug overdose deaths has increased every year except 2018.

    A growing share of deaths continue to come from overdoses involving fentanyl, a class of potent synthetic opioids that are often mixed with other drugs, and methamphetamine, a synthetic stimulant. State health officials battling an influx of both drugs said many of the deaths appeared to be the result of combining the two.

    Drug overdoses, which long ago surged above the country’s peak deaths from AIDS, car crashes and guns, killed about a quarter as many Americans last year as Covid-19.

    Deaths involving synthetic opioids — largely fentanyl — rose to 71,000 from 58,000, while those associated with stimulants like methamphetamine, which has grown cheaper and more lethal in recent years, increased to 33,000 from 25,000. Because fentanyl is a white powder, it can be easily combined with other drugs, including opioids like heroin, and stimulants like meth and cocaine, and can be stamped into counterfeit pills for anti-anxiety drugs like Xanax. Such mixtures can prove lethal if drug users are unaware they are taking fentanyl or are unsure of the dose.

    Deaths from both classes of drugs have been rising in recent years.

    But there is growing evidence that mixing stimulants and opioids — into combinations known as “speedballs” and “goofballs” — is becoming more common, too. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco, who studies drug markets, has just begun a multiyear study of the combination of opioids and meth.

    “There’s an intertwined synthetics epidemic the likes of which we’ve never seen,” he said. “We’ve never seen a powerful opioid such as fentanyl being mixed with such a potent methamphetamine.”

    The numbers released on Wednesday are considered provisional, and may change as the government reviews more death records. But they showed that a crisis that escalated sharply during the first year of the pandemic does not appear to be letting up.

    Regina LaBelle, an addiction policy expert at Georgetown University, said that while the nearly 108,000 estimated deaths were without precedent, the smaller increase relative to 2020 was a “hopeful sign.”

    “One year doesn’t make a trend,” she said. “We’re going to have to look at a few years in a row.”

    The White House in recent weeks announced President Biden’s first national drug control strategy, and a plan to combat meth use was unveiled last week by his drug czar, Dr. Rahul Gupta, the first medical doctor to oversee the White House Office of National Drug Control Policy. Overdose deaths involving meth almost tripled between 2015 and 2019 in people 18 to 64, according to the National Institutes of Health.

    “It is unacceptable that we are losing a life to overdose every five minutes around the clock,” Dr. Gupta said in a statement on Wednesday.

    Mr. Biden is the first president to embrace harm reduction, an approach that has been criticized by some as enabling drug users, but praised by addiction experts as a way to keep drug users alive while providing access to treatment and support.

    Instead of pushing abstinence, the approach aims to lower the risk of dying or acquiring infectious diseases by offering sterile equipment — through needle exchanges, for example — or tools to check drugs for the presence of fentanyl. Strips that can detect fentanyl have become increasingly valuable resources for local health officials, and some states have moved recently to decriminalize them, even as others resist.

    Recent settlements with prescription opioid manufacturers and distributors will soon bring new resources to states battling the overdose epidemic.

    The causes of the continued increase in overdoses are complex and hard to untangle, experts said. But state health officials and some addiction experts said the spike in overdoses, which began before the pandemic, could not be blamed solely on the disruptions that came with it, or on a major increase in the number of Americans using drugs.

    Social isolation and economic dislocation, which have been widespread during the pandemic, do tend to cause relapses in drug use, and could have contributed to rising overdoses. Shutdowns early in 2020 also caused some addiction treatment providers to temporarily close their doors. But the pandemic alone does not explain the recent trend.

    Policy changes made during the pandemic may have helped prevent more deaths. Ms. LaBelle, the Georgetown addiction expert, said early research had found that loosening rules to permit take-home methadone treatment had been beneficial, along with an increase in treatment via telemedicine.

    “The difference in what we’re seeing now is not how many people are using,” said Dr. Anne Zink, the chief health official in Alaska, which saw the largest overdose death percentage increase of any state in the nation, according to the data released on Wednesday.

    Instead, she said, the fentanyl supply had skyrocketed, in shipments that were difficult to track, penetrating even the most isolated parts of the state. Of the 140 fentanyl overdose deaths the state recorded in 2021, over 60 percent also involved meth, and nearly 30 percent involved heroin.

    Fentanyl, which is made in a lab, can be cheaper and easier to produce and distribute than heroin, enhancing its appeal to dealers and traffickers. But because it is strong and sold in varying formulations, small disparities in quantity can mean the difference between a drug user’s usual dose and one that proves deadly. It is particularly dangerous when it is consumed unwittingly by drug users who do not usually take opioids. The spread of fentanyl into an ever-growing portion of the nation’s drug supply has continued to flummox even states with strong addiction-treatment services.

    Often synthesized in Mexico from precursor chemicals made in China, fentanyl long ago permeated the heroin markets of the Northeast and the Midwest. But recent data shows it has established a strong hold in the South and the West as well.

    “The economics of fentanyl have just been pushing the other drugs out of the market,” said Dr. Joshua Sharfstein, a vice dean of the Bloomberg School of Public Health at Johns Hopkins University. “It’s just so cheap to buy fentanyl and turn around and put it in whatever.”

    Across Alaska, Dr. Zink said, fentanyl kills many overdose victims before bystanders or emergency responders can revive them with naloxone, a medication that can quickly reverse an opioid overdose.

    “You don’t have a second chance if you don’t immediately have naloxone available,” she said.

    A recent study of illicit pills seized by drug enforcement authorities found that a substantial share of what is marketed as OxyContin, Xanax or the attention deficit hyperactivity disorder drug Adderall now contains fentanyl. The spread of these counterfeit pills may explain a recent sharp increase in overdose deaths among teenagers, who are less likely to inject drugs than older people.

    Pat Allen, the Oregon Health Authority director, said that, as was the case in other states with surging overdose deaths, the clear difference in 2021 had been the ubiquity of fentanyl. Children as young as 12 are considered at high risk of obtaining counterfeit pills containing fentanyl, and high schoolers are overdosing on them, believing they are opioid painkillers or anti-anxiety medication. The state was working to send naloxone tool kits to schools, similar to a program it has used in fast food restaurants, where people were overdosing in bathrooms.

    Mr. Allen said he had seen an alarming phenomenon among those who overdose: They perceive the risk of fentanyl to be low, even though the actual risk is “gravely higher.”

    “We’ve had an addiction issue in Oregon which we’ve known about for a long time,” he said. “This takes that existing addiction issue and makes it much more dangerous.”

    In 2021, overdoses amounted to one of the leading causes of death in the United States, similar to the number of people who died from diabetes and Alzheimer’s disease, and roughly a quarter of the number of people who died from Covid-19, the third leading cause of death, according to the C.D.C.

    In Vermont, which saw one of the biggest increases in overdose deaths last year, 93 percent of opioid deaths were fentanyl-related, according to Kelly Dougherty, the state’s deputy health commissioner.

    “In the beginning stages of the pandemic, we were attributing the increase to life being disrupted,” she said. But now, she added, a different explanation seems clear: “What is really the primary driver is the presence of fentanyl in the drug supply.”

    The state’s celebrated “hub and spoke” model of addiction treatment and its aggressive use of medication-assisted treatment programs, she said, were not enough to contend with the ease and speed with which people overdose on fentanyl.

    “You can have the most robust treatment system,” she said, “and not everybody is going to avail themselves of it when maybe they should, or before they end up overdosing.”

    And fentanyl is showing up in counterfeit pills, Ms. Dougherty said, including in OxyContin.

    She said Vermont officials had taken up new public messaging regarding fentanyl.

    “Just assume that it’s everywhere,” she said.

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