Explaining the issues

The opioid crisis: Who calls the shots, from D.C. to Philly

A no-frills explainer on the deadly epidemic.

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The U.S. lost more than 72,000 residents to drug overdose fatalities last year, according to preliminary federal data.

That’s one American every nine minutes. The crisis has quickly outpaced the deadliest years the HIV/AIDS epidemic, a reality driven largely by synthetic fentanyl and its analogues, which have saturated the nation’s illicit drug market in the last three years.

From a policy perspective, preventing fatalities is just one component in the tangled bureaucratic matrix surrounding opioid addiction, which includes harm reduction, homelessness, healthcare and substance abuse treatment.

It’s never a simple equation, but here’s a brief overview of who controls what when it comes to this epidemic.

The biggest debates

  1. Expanding medication-assisted treatment: Many say solving the crisis begins with investing billions in medication-assisted treatment. Public health experts believe medications such as methadone, buprenorphine and naltrexone are the gold standard for opioid use disorder. While federal lawmakers talk about the crisis, they have been slow to allocate funding for treatment beyond a fraction of what critics say is needed.
  2. Curbing prescription opioids: In response to the crisis, governments have begun closely monitoring the number of prescriptions written. Champions say the practice has quashed the pharmaceutical excesses of 1990s and 2000s, which has been accused of fueling the crisis by getting millions addicted to pain medication. Some epidemiologists say there’s no evidence prescription drug monitoring actually works to reduce addiction levels.
  3. Implementing harm reduction practices: The phrase “harm reduction” has become ubiquitous in talk about this crisis. But what does it mean? It can include distributing naloxone, an opioid overdose reversing agent; offering syringe exchange services, as Kensington’s Prevention Point does; and most controversial of all, opening safe injection sites — facilities where people can use drugs under medical supervision while also accessing treatment options and other resources. Critics of harm reduction generally argue such practices promote rather than discourage illicit drug use.

How national policy can address the opioid crisis

Even if you take ending the war on drugs and making everything legal off the table, the federal government wields incredible power here: it has the ability to to allocate resources to each state by expanding access to medications like methadone and buprenorphine.

Experts estimate tens of billions of dollars of investment is needed on this front nationwide, but so far, Congress and President Donald Trump have been slow to show commitment to increasing funding to that next level. In the last two years, Pennsylvania has won a combined $52 million in federal grant money to combat the crisis.

How state policy can address the opioid crisis

While not in the same capacity as the federal government, Harrisburg can also allocate more public funds to local drug treatment efforts.

The state has made strides to crack down on the over the over-prescription of opioids. The Department of Health has implemented a prescription drug monitoring system, collecting data on every script filled for a controlled substance across the state.

From a criminal justice angle, Pennsylvania has also taken a contentious prosecutorial approach to opioid crisis. Attorney General Josh Shapiro has been aggressively pursuing death charges for those who deal or deliver drugs. State lawmakers added this charge — the equivalent of third-degree homicide — to the AG’s arsenal in 2011. Critics lambast the practice as a wrongheaded “war on drugs” approach. So far, the trials have netted mixed results.

In terms of harm reduction, the state government has stepped in to expand the availability of overdose-reversing naloxone. In 2015, Gov. Tom Wolf signed a standing order that essentially made the life-saving antidote available to all Pennsylvanians over the counter.

How city policy can address the opioid crisis

Philadelphia is one of several big cities racing to open the nation’s first safe injection facilities, in the face of federal pressure from U.S. Attorney General Jeff Sessions. Philly has even faced threats at the state level, from Republican lawmakers who oppose the controversial proposals. On the Democratic side, neither Shapiro nor Gov. Tom Wolf support safe injection sites either.

Philadelphia Health Commissioner Dr. Thomas Farley estimated that a drug consumption facility would save around 75 lives per year — just a fraction of the 1,200 drug overdose fatalities the city saw in 2017. Beyond that, local health officials have also been doing their part to expand access to naloxone and offering other harm reduction services to the city’s opioid addicted population.

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