In this time of political divisiveness within these United States, might managing the opiod crisis be one issue on which both Republicans and Democrats can find some common ground? Earlier this year President Trump, with the support of both parties, signed an omnibus funding bill which allocated $6 billion dollars to combat the opiod crisis. But, it is not only President Trump who has advocated for naxolone treatments being easily available to those at risk. New York City Mayor Bill DeBlasio has taken this initiative a step further by proposing safe injection sites known as Overdose Prevention Centers and has gone as far as launching a $500 million lawsuit against manufacturers of prescription opiods. The mayors of San Francisco, Philadelphia and Seattle have thrown their support behind this proposal and, indeed, have already established safe injection sites in their respective cities.
By rendering naxolone in the form of Evzio (an injectable) and Narcan (a nasal spray) readily available, policy makers have conceded that the U.S. does not know how to manage the opiod crisis. The numbers speak for themselves; in 2016, approximately 42,000 Americans died from opiod overdoses and by June 2017 that number climbed to 67,000 (according to preliminary data from the Centers for Disease Control). That this crisis is impervious to economic, racial and geographic barriers is perhaps why both parties are unified in providing easy access to naxolone as a possible solution. The deleterious effects of these deaths on families and communities have been well documented. While both rural & poor inner city areas remain the most susceptible to opiod fatalities, addiction has also found its way into the more affluent strata of society.
Mayor DeBlasio’s efforts to create safe injection sites is adding another dimension to the national plan and some question whether this is going too far. His strategy is not without obstacles on both the state and federal levels. The mayor’s long-standing feud with fellow Democrat Governor Cuomo will certainly create a stumbling block as well as a statute which stipulates that such sites violate federal law. Under federal law, known as the crack house statute, it is illegal to operate locations for the distribution of controlled substances. However, there are loopholes to these federal encumbrances. A precedent has been set by the needle exchange programs established in the 1990’s to combat the spread of HIV; an argument can be made that this too is an epidemic of sorts. Equally, if it is presented under the guise of a research study, then this plan can be authorized by the state health commissioner. Per the mayor’s proposal, these centers will be domiciled within non-profit organizations that already provide needle exchange programs and it will be less disruptive to local communities.
Many liberals in favor of safe spaces argue that controlled administration can counter overdosing and at the same time provide treatment. Conservatives make the case that safe spaces do little if anything to identify and neuter the cause(s) of addiction, coddle addicts and normalize addiction. Ironically, many residents who are in favor of safe spaces but live in the vicinity of where one would be built, suddenly invoke a NIMBY position, arguing that a “safe space” will make their neighborhoods less desirable because of an influx of addicts, the homeless and criminals. Ultimately, the mayor and those endorsing these sites see this as a response to a public health crisis where previous solutions have been abject failures.
In today’s vernacular, the term “new normal” is loosely thrown around as justification for radical shifts in culture and society that cannot be easily countered. No one dare explicitly use this term when referring to the opiod crisis but our policy makers have implicitly done just that. Treatment via naxolone, counseling and a whole cornucopia of local and federal funding is seen as THE only solution. The alternatives are heavy fines and prison time in our already teeming penitentiaries, neither of which addresses the fundamental problem of addiction. When delving deeper, many of these opiod related deaths are accidental and occur when a cocktail of various substances, including painkillers and heroin, are consumed. Indeed, there is also the issue of single substance addition such as to Oxycontin where addiction is somewhat easier to treat.
While Narcan and Evzio resuscitate those overdosing, they do nothing to counter addictive behaviors. Emergency rooms are increasingly appointing former addicts to be on hand for counseling overdose survivors, many of who suffer from self-loathing for their addiction. For those, this deeply entrenched sentiment perpetuates the cycle and they argue that they want help. But, there is an argument to be made that by making naxolone readily available, those who want to tinker with opiods are lulled into a sense of safety should their little experiment not work out.
In addition to the issue of whether or not policymakers are normalizing addiction by endorsing naxolone, another danger is the public perception of easy availability and plentiful supply when that is not the case. As an example, The New York Times verified this in an investigative piece on Mayor DeBlasio’s initiative known as HealingNYC, a program to treat opiod addiction. In 2015, the mayor decreed that Narcan can be sold without a prescription and that everyone, including minors could have access to the medication. In lieu of a doctor’s prescription, under what is known as a standing order, pharmacists use Health Commissioner Mary T. Basset’s to procure the medication. In an article dated on April 14, 2018, The New York Times found that only 270 of the city’s 720 pharmacies have stocks of Narcan; of those, 90 still require a prescription. Worse still is that in the Bronx which has the highest opiod death rates in the city, only 25 pharmacies carry Narcan over the counter. Put Simply, this is cause for alarm in a city where there are between 60,000-80,000 addicts. If this is the case in New York that is waging one of the most aggressive wars on opiods, then the rest of the country needs to take heed as do the policymakers who have served up naxolone products as a panacea. Ultimately, the disconnect between perception and reality runs the risk of further exacerbating this crisis in what would be another case of good intentions going awry.