Opinion | In the Opioid Epidemic, More Reasons for Hope Than Despair

It’s been more than two decades since Purdue Pharma released its patented pain medication OxyContin to an unsuspecting public. Since then, more than 500,000 people have died in the United States in an addiction and overdose crisis triggered by the excessive marketing and overuse of that drug and others like it. Thousands of lawsuits have been filed against Purdue and other opioid makers, but for the most part only small-time scapegoats — street dealers and opioid users — have truly been held to account for the epidemic.

That picture won’t change much on Monday, when one of the nation’s biggest opioid settlements is set to be effectively resolved. A federal judge is expected to certify Purdue’s bankruptcy plan, which sits at the center of a $4.5 billion settlement between the company and thousands of state and municipal governments that have sued for damages related to the opioid epidemic. In many ways, that settlement is atrocious. Members of the billionaire Sackler family, which owns Purdue and profited most heavily from the company’s opioid dealings — will not have to admit to any wrongdoing. They will secure near-total immunity from any future litigation, and by the time the settlement is paid out they most likely will be as wealthy as they ever were.

But the deal will achieve at least some good: Millions of pages of documents, detailing the full scope of the company’s malfeasance, will be made public. Communities across the country will finally receive some of the money they need to address the ongoing crisis. And the resolution of so many lawsuits at once will bring a small measure of closure to a plague that has felt interminable and shows no signs of abating. That is nothing to scoff at, for a nation weary of epidemics and starved for closure of any kind.

As one chapter in this long and terrible story ends, it’s crucial not to lose sight of the human faces behind the grim statistics. Five hundred thousand is an incomprehensible figure, even — or especially — in the age of Covid. It includes sons and daughters and siblings and parents and spouses and friends. It includes the suffering of all the people who loved them. It includes so much heartache and despair that hardly anyone in America today remains untouched by it. And, of course, there are the two million or so more people who are still living, and struggling, with opioid use disorder and its consequences.

In the face of that struggle, it’s important to remember that there are still more causes for hope than for despair.

For starters, we know what does and doesn’t work against addiction epidemics. Criminalization of drug use, and the war on drugs that undergirds it, has been a dismal failure by just about every conceivable metric. People suffering from substance use disorders have been stigmatized, nonviolent drug offenders remain imprisoned and the crisis has continued unabated.

What does work is evidence-based treatment and harm reduction. Decades of data make clear that medication assisted therapies like methadone and buprenorphine can cut the mortality rate of opioid addiction in half. Likewise, the balance of evidence shows that harm reduction programs — like needle exchanges, safe injection sites and routine use of the overdose reversal drug naloxone — can reduce the number of overdose deaths by helping people with opioid use disorder consume these drugs more safely.

After years of dithering followed by a surge in overdose deaths, we now have an administration that seems capable of making these distinctions between effective and ineffective approaches to the crisis. President Biden campaigned on a bold and refreshing plan for ending the opioid epidemic: $125 billion over 10 years for a hopeful roster of evidence-based programs. What we need now is for the administration and Congress to push these plans forward with funding and initiatives.

Congress recently allocated $30 million through the American Rescue Plan for harm reduction programs, including needle exchanges and fentanyl test strips. That’s the first time federal money has been given to such programs, and it’s a welcome step. But elected officials can and should do much more: Medication-assisted therapy programs are desperately needed in American communities and throughout the prison system. Addiction treatment facilities also are in need of investment and, perhaps more important, better regulation and oversight. And the nation as a whole needs to get real about disrupting drug supplies: Border walls will not work, but, as Washington Monthly notes, pulling the levers of trade policy might.

Likewise, it’s past time to tackle the root causes of addiction, including income inequality and untreated mental illness.

The settlement money, from the Purdue case and others, will also help. That money will not be nearly enough for every community to address the full scope of the opioid epidemic. But if it’s spent wisely, with an eye toward what the evidence says actually works, it will have an impact. There’s still a lot of work to do, but if lawmakers and other officials step up, there’s no reason the nation can’t finally bring this epidemic to an end.

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