August 19th, 2016
The small city of Huntington, West Virginia made national headlines this week after experiencing a wave of at least 26 overdoses in a period of four hours, reportedly after a “bad batch” of heroin entered local circulation.
It was one small, dramatic example of America’s wider problems with opioids. Many observers have understandably wrung their hands. But what constructive points can we take away from something so troubling?
1. Naloxone Saves Lives—It Should Be Made Available Everywhere
Out of the 26 to 28 Huntington overdoses variously reported, there were only two fatalities. This is in large part thanks to the increased availability of naloxone (the drug that reverses opioid overdoses) in West Virginia.
Last year, Governor Earl Ray Tomblin signed a bill that expanded access to naloxone, and Cabell County police, ambulance crews and firefighters all now carry it. Huntington EMS responders reportedly administered naloxone to at least 10 individuals at a single location this week.
2. People Who Buy Illegal Drugs Don’t Know What They’re Getting—Regulation Would Help Protect Them
Unregulated illicit markets leave people who choose to use drugs completely unprotected. Drug-testing at music events, for example, shows that many people consume substances that are entirely different from the ones they thought they’d purchased. Even if you do get what you asked for, you don’t know its purity.
Most drug fatalities, it should be remembered, involve combinations of different drugs; “overdose” is often a misnomer. We don’t know exactly what was in Huntington’s “bad batch.” But street heroin is often laced with other, more powerful opioids, such as fentanyl, or with entirely different substances.
If heroin were provided by a regulated legal source, whether in the form of medically supervised heroin-assisted treatment (HAT) or otherwise, people who use it would be protected from many dangerous uncertainties.
3. Let’s Not Take It Out on the Dealers
As The Influence has frequently related, there is a disturbing tendency for the US legal system to scapegoat drug dealers in cases of drug-related deaths—sometimes even imposing life sentences on people who clearly had no intention of killing anyone. Contrary to popular belief, most drug dealers are not rich—and with communities sharing and buying for each other, the line between “user” and “dealer” is often not a meaningful one.
The same vindictive rationale could be used to sentence a liquor store clerk in the case of someone who died of alcohol poisoning. Misplaced revenge has no place in a civilized justice system. Such knee-jerk prosecutions are inhumane and serve no purpose—if the failed War on Drugs has taught us anything, it’s that draconian sentences for drug “offenses” don’t reduce demand.
4. There Are So Many Other Practical Things We Should Be Doing
Several more immediate steps that could help include greatly expanding access to buprenorphine and methadone—lifesaving maintenance drugs that are bafflingly restricted in the US—as well as much more honest drug education, and greater efforts to engage young people around the social issues that often accompany problematic drug use. Evidence-based drug treatment should be available to those who choose it (thought not mandated or coerced).
And supervised injection facilities have been proven to work—reducing fatalities, disease and crime—in many parts of the world. It’s high time we had them in the US, as a few of our bolder political leaders have recognized.
5. We Need to Address the Root Causes of Addiction
West Virginia has the highest rate of fatal overdose in the country, with 35 out of 100,000 residents dying per year. It has suffered from well-documented economic problems—and last December became the only US state since records began in 1976 to have a working-age labor force participation rate of below 50 percent. Huntington, where economic problems have been particularly acute following the collapse of the region’s steel industry and other factors, was dubbed the nation’s “unhealthiest city” back in 2008. It suffers from high drug fatalities even by West Virginia standards: In 2015, the city of fewer than 50,000 experienced 58 drug-related deaths.
The link between opioid problems and economic suffering is pretty clear, and ought to focus us even more on compassionate, common-sense responses rather than punitive ones. Economic regeneration itself would be a major part of a long-term solution.