Imagine: A health crisis claiming over 16,000 lives each year. Then imagine a prescription drug that could be made widely accessible to save those lives, but isn't.
This is not a hypothetical situation. Overdose deaths have surpassed car crashes in the United States as the second leading cause of accidental death. Drug overdose was responsible for over 41,000 deaths in 2011, and over 16,000 of those deaths were attributable to opiates.
For the most part, the public is unaware that naloxone, a safe and effective opiate antagonist can reverse opiate-related overdose and save lives.
Emergency medical technicians and doctors in hospital emergency rooms have used naloxone for decades. Prior to 2000, limiting access to a medical setting may have been acceptable. However, overdose deaths have increased every year since 2000 and warrant broader distribution and increased access.
Absent a timely and strategic response from federal agencies, advocates have taken the lead, supporting laws that empower community-based organizations, state and local health departments, and others to remove the barriers to naloxone access.
As Overdose Awareness Day approaches, harm reduction advocates can celebrate that 29 states and Washington, DC have enacted legislation to improve naloxone access. Provisions include programs protecting prescribers from civil/criminal liability, allowing prescription by standing order, and/or removing criminal liability for possession of naloxone without a prescription.
Still, the number of such programs remains woefully inadequate in many states and non-existent in others. My organization, Mothers Against Teen Violence, is working to assure that a naloxone access bill is introduced when the Texas legislature convenes in January.
But even in states where the laws are permissive, barriers to access persist. According to an article on the topic published in the November 12, 2012 issue of the Journal of American Medical Association:
Multiple barriers limit the diffusion of this innovation: the price of naloxone has sky-rocketed in the context of a severe shortage; few prescribers are aware of and are willing to facilitate overdose prevention education and naloxone access; funding for program activities and evaluation research.
Rising prices notwithstanding, stigma and shame are surely at play here.
The poor and people of color are overrepresented among those arrested for drug possession, while their white middle-class counterparts are more likely to experience overdose. Incarceration and overdose represent two sides of the same coin. Both carry stigma and shame and both are perpetuated by the War on Drugs.
The drug war stigmatizes and dehumanizes people who use drugs, responding with punishment to an issue that could be handled more effectively by the public health sector. Stigma breeds shame and a sense of unworthiness, which can prevent affected persons and their loved ones from demanding the kinds of services available to sufferers of other diseases.
On August 31st, organizations across the United States will engage in actions aimed at increasing awareness about substance abuse disorder, overdose and the need for increased access to naloxone.
Opiate overdose is the crisis that did not need to happen. Its existence contradicts the idea that every human life is worth saving. The time has come to overcome shame, stigma and ignorance and bring this crisis to an expeditious and sure end. To do less is inhumane.