Commentary: Epidemic of drug-related deaths requires public health response

A nation of laws, not men — a principle undergirded by a system of checks and balances designed to secure liberty and justice for all. In striving to live up to these ideals, the work always begins with owning up to the reality of injustice. When we are silent on the rights of others, or when the will of those in power is forced on the voiceless, we stray dangerously far from justice for all.

I have come to understand that our decades of failed drug policies represent a blatant violation of human rights. The tragic loss of life is no secret: The national death toll from overdoses, steadily rising since 1999, is now more than 100,000 annually. Here in Maryland, slight regional fluctuations notwithstanding, annual overdose fatalities have more than quadrupled during the past decade. These startling numbers represent people — our children, our siblings, our neighbors — whose opportunities for a healthy future and a productive life were thwarted by barriers to proven interventions.

The devastation of these preventable deaths, along with the untold suffering of countless others, should ring an alarm among our lawmakers. Yet, meaningful progress evades us. This is a mystery in light of the preponderance of research and data analysis of public policy research organizations, including The Pew Charitable Trusts, the CATO Institute and the RAND Corporation as well as leading health institutions such as the American Medical Association, all providing remarkably aligned action steps and urging policymakers to address them accordingly.

Despite the road map and the horrific pain of this epidemic, our response has been insufficient, with efforts that are piecemeal or half-hearted and that lack coordination. What’s clear is that the solution to ending the overdose crisis requires a full commitment to building a public health response that is forged collaboratively. As AMA President Dr. Jack Resneck Jr. underscores in the 2022 AMA Overdose Epidemic Report, “Preventable deaths and other harms continue because of multiple, overlapping public health and public policy half-measures.”

Year after year, the crux of the problem confronts us: What should be treated as a public health emergency is too often dealt with as a criminal disorder. While the urgency and the repetition of this commonsense plea have prompted its emergence in our talking points, the words ring hollow when policies continue to criminalize behavior that is hardly a crime, denying health interventions proven to save lives.

This legislative session, our Maryland lawmakers again stood up for the status quo of criminalizing possession of drug paraphernalia (without any drug). Not only does this practice place more people into the criminal justice system, but it runs counter to everything we know about the imperative to promote health care over punitive measures.

Syringe service programs are a case in point. Long endorsed by the World Health Organization and its cohorts, these programs have an impressive track record. They lower overdose deaths and reduce the spread of infectious diseases such as HIV (of particular concern locally considering Maryland’s high infection rate). Program participants are five times more likely than nonparticipants to seek treatment and about three times more likely to stop drug use. These programs do not enable drug use, but instead enable health and provide hope.

The reality is that people use drugs. Rather than respond with arrests and condemnation — approaches that have never promoted health and well-being much less recovery — we can offer services that reduce the harms of drug use. It is important to understand that fear of arrest doesn’t deter drug use but instead deters safe drug use.

I can’t help but wonder whether elected officials who favor criminalization actually believe that it helps save lives or if there is some other motivating principle. Is it justice? Humanity? Who does it help? If you think about the subsets of people whose lives interface with our current drug crisis — from drug users and their families to law enforcement and treatment providers — who among them needs the most help? Who is the most vulnerable, at risk of illness and death? When we fail to stand up for the marginalized, there has to be a reason.

In 2021, the bill to decriminalize paraphernalia passed in the Maryland House of Delegates and the Senate only to be vetoed by then-Gov. Larry Hogan. In 2022, legislation was offered but didn’t advance. In 2023, legislation passed the House but didn’t get Senate consideration.

As we continue to kick this can down the road — ignoring definitive data and solutions that promote well-being, such as overdose prevention services — we are making the choice to condemn those who suffer. A humane approach is needed, and with the lives of vulnerable citizens (who are not guilty of violating the rights of others) at risk, there is no time to waste. Any further study is merely an excuse to justify doing nothing and perpetuating the stigmatization of those who need care.

People familiar with the research are passionate about public health interventions and have been publishing persuasively for years. Ricky Bluthenthal, associate dean for social justice and a professor in the Department of Population and Public Health Sciences at the University of Southern California’s Keck School of Medicine, is emphatic: “For too long, we have been operating under the misunderstanding that giving resources to people with a drug problem just perpetuates their drug problem. But our research indicates this is false. The data shows that funding evidence-based solutions reduces the spread of infectious disease, keeps people stable in treatment, and stops them from dying. These are the outcomes everyone wants, but too often stigma against people who use drugs undermines efforts.”

“We’re approaching the overdose crisis all wrong,” writes Dr. Sarah Wakeman, medical director for Substance Use Disorder at Mass General Brigham and a professor of medicine at Harvard Medical School, in a recent MedPage Today article. “Yet, rather than investing in effective and humane strategies to reduce mortality, we have spent a century criminalizing certain types of drug use and certain populations who use drugs. And we have doubled down on and funded ineffective and frankly harmful approaches, while not adequately supporting treatment and harm reduction interventions proven to reduce overdose death. We are now seeing the result of these years of failed policies and approaches.”

I am proud of Maryland on many fronts and I am grateful for the humanistic principles that were evident as this legislative season came to a close. But the refusal to reduce the incidents of criminalizing our most vulnerable citizens is hard to understand. Condemning, rather than caring for, those who struggle with addiction leads to broken lives and defies common sense. Could it be that the will of those in power is forced on the voiceless? Sadly, I think it is, but I don’t understand why.

Jessie Dunleavy, author of “Cover My Dreams in Ink: A Son’s Unbearable Solitude, A Mother’s Unending Quest,” a memoir chronicling her son’s life and overdose death, is a lifelong resident of Maryland and an advocate for drug policy reform.

jessiedunleavy.com

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