The insanity of addiction treatment in America

Abstract

Confirming early fears of accelerated drug overdose deaths in 2020, over 93,000 Americans died last year of a drug overdose—the greatest overdose-involved loss of life in a single year. National survey results reveal that 40% of people with a substance use disorder who do not receive treatment report that they are ‘not ready to stop using’ and 42% do not receive treatment due to stigma, underscoring the need for greater adoption of harm reduction strategies. In the face of surging drug overdose deaths, American policymakers and treatment professionals continue to stand by the same approaches while expecting different results. Evidence-based, life-saving interventions include medications for opioid use disorder, low-threshold bridge clinics in emergency crisis settings, co-prescription and community distribution of naloxone anti-overdose kits, drug checking services (fentanyl test strips), syringe services programs, and overdose prevention sites. Despite strong research support and national lip-service to ‘evidence-based’ and ‘patient-centered’ approaches, harm reduction remains highly underutilized and widely unaccepted by the treatment community. Fortunately, the American government has taken several steps in recent months in terms of increased funding and the elimination of many strict, often arbitrary federal regulations, signaling the beginning of a potential shift in federal drug policy. This paper reviews available evidence with an eye toward the current state of affairs and offers actionable steps for researchers, treatment administrators, clinicians, and policymakers to make the case for greater adoption of harm reduction to address the drug overdose crisis.