How the government plans to prevent another record year of overdose deaths

A new $30-million grant program focuses on reducing the harms of drug use and stigma of addiction. Plus: The book that has me nostalgic for the pre-internet age.

Photo by Mike Erskine on Unsplash

The Centers for Disease Control and Prevention released some tragic news before Thanksgiving last month: More than 100,000 Americans — one every five minutes — died from drug overdoses between May 2020 and April 2021. It’s the most recorded in a single year and an increase of 28.5 percent from the same period the year before. Put another way, we’re losing enough people to addiction every day to fill a 757 passenger jet. And the spike wasn’t just from one drug. Overdose deaths from fentanyl, methamphetamine, cocaine and prescription pain medication were all up. Add in the weariness of a prolonged pandemic and persistent stigma against people who use drugs and it’s no wonder we’ve got the makings of an urgent crisis.

So I jumped this morning at an invitation from the US Department of Health and Human Services to hear from Sec. Xavier Becerra and two other top public health officials how they plan to solve it. The leaders announced a new $30 million grant program administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) focused on reducing overdose deaths and the harms of drug use.

As devastating as the data on overdose deaths is, Sec. Becerra said they fail to tell the full story. “We see it in the faces of grieving families. We hear it in the blaring sirens and panicked 911 calls. We read it in the obituaries of sons and daughters gone to soon because help came too late,” he said. “For decades, our society tried to stigmatize and punish those with addiction. But we know the so-called ‘War on Drugs’ was actually just a ‘War on People.’”

The National Harm Reduction Coalition, an advocacy group for people and communities affected by drug use, says harm reduction is both a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use and also “a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.” Dr. Rahul Gupta, director of National Drug Control Policy (ONDCP) at the White House, said this morning that harm reduction at the federal level means placing lives at the center and creating conditions where it becomes easier to save a life than to let one perish. In terms of policymaking, he said it means to act based on science, evidence and data.

The SAMHSA grant program, funded by the American Rescue Plan President Joe Biden signed in March, will distribute $10 million per year over the next three years. Grant recipients must use the resources to support harm reduction services like the provision of sterile syringes, safe-sex kits, prevention education about synthetic opioids and other substances and overdose prevention kits including distribution of naloxone — a medicine that rapidly reverses an opioid overdose. Service providers can also offer peer worker engagement, medical services, case management and referral to treatment.

Sec. Becerra acknowledged that overcoming addiction rarely happens overnight and the grants are one step in HHS’s comprehensive strategy, which also includes primary prevention, evidence-based treatment and recovery support. “Where we can't prevent someone from using these substances, we should at least be trying to make sure we prevent severe consequences like death” by “not silencing them, stigmatizing them, or pushing them into the shadows.”

Dr. Miriam E. Delphin-Rittmon, assistant secretary for mental health and substance use at HHS and the leader of SAMHSA, said that the funding will reach every segment of society, especially those in historically underserved communities who were the target of the previous federal anti-drug initiatives. “Our communities are looking for practical strategies to help their loved ones,” she said. “And we believe this funding opportunity is a giant step forward for our nation.” Delphin-Rittmon added that SAMHSA views substance use disorder as a chronic condition and returning to drug use is often part of the recovery process. Instead of viewing abstinence as the only positive outcome, the agency views any quality-of-life improvements as an opportunity to treat people who are using with dignity, compassion and respect.

The ONDCP also announced a new proposal that state legislators can adopt for expanding access to syringe service programs, which it says can prevent the spread of disease, save lives, and connect people to other health services, including treatment for substance use disorder. The National Harm Reduction Coalition’s website said these programs reduce the risk of exposure to unnecessary risk of contracting infectious diseases like HIV and hepatitis C by as much as 50 percent. “And they offer a place to connect with other resources like housing, health care and drug treatment.”

For some people who have been doing this work for years though, today’s announcement feels like déjà vu.

When overdose deaths from fentanyl and heroin soared during the last decade, the Obama administration answered with its own response that features some of the current strategies from Biden’s HHS. In September 2016, President Barack Obama declared a week in September as Prescription Opioid and Heroin Epidemic Awareness Week and announced a series of actions senior officials in his Cabinet and across federal agencies planned to take to stem the rise in overdose deaths.

Obama called on Congress back then to provide $1.1 billion in new funding to enable everyone who wanted treatment from what the administration called an “opioid use disorder” could receive it. Five years later, it’s Dr. Gupta who is urging Congress to pass Biden’s budget to unlock the $41 billion earmarked to treat addiction and prevent overdoses. It’s a sobering reminder of the three things in life that are certain: death, taxes and a Congress that slow-walks presidential priorities.

Still, Dr. Delphin-Rittmon said there are some differences between then and now. For example, this is the first time that federal funds can be used to purchase fentanyl test strips, which can identify the presence of the opioid in unregulated drugs, including injectables, powders and pills — a move inspired by listening to community organizers who are on the ground and responding to and living through these crises. She also mentioned the administration’s strong support for recovery. In addition to harm reduction, HHS is looking to support and further expand recovery services for communities to identify hotspots and high-need areas.

Dr. Delphin-Rittmon said SAMHSA will be accepting applications through the beginning of February and is accepting applications as soon as it can receive them. Once they’ve scored the applications, they plan to make awards — a process that should be complete by the end of the first quarter next year from the sounds of it.

“We encourage people to check out our website and let communities know about this notice of funding opportunity and to share it far and wide,” she said. “Because we know that there’s quite a bit of innovation already happening out there and we are very interested in supporting that work to help save lives.”

Editor’s Note: People searching for treatment for substance use disorders can find options by visiting findtreatment.gov or by calling SAMHSA’s National Helpline, 1-800-662-HELP (4357).

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