America’s Out-of-Control Drug Overdose Crisis

“More Americans than ever are dying fromfentanyl overdoses as the fourth wave of the opioid epidemic crashes throughevery community, in every corner of the country,” reported Nadine Yousif on BBC News in September.

A recent study by researchers at theUniversity of California, Los Angeles, outlined the four waves: “The UnitedStates overdose crisis has escalated in an exponential fashion for over fourdecades, yet with a shifting profile of drugs implicated in each successive ‘wave’of the crisis. The first wave of the overdose crisis is typically argued tohave begun in the late 1990s or early 2000s with the rise of deaths involvingprescription opioids, the second wave beginning in 2010 driven by a shift toheroin, and the third wave beginning in 2013 driven by illicit fentanylanalogs. Recently, scholars have argued that the ‘fourth wave’ of the USoverdose crisis has begun, in recognition of rapidly rising polysubstanceoverdose deaths involving illicitly manufactured fentanyl, with stimulantsplaying a key role.”

In 2018, in a rare moment of bipartisanship,Republicans, Democrats, and former President Trump came together aroundlegislation that dedicated $20 billion to the treatment and prevention of andrecovery from drug addiction. Five years later, the SUPPORT Act has lapseddespite the fact that the number of Americans dying from drug overdoses hasincreased by more than 60 percent in those five years—largely driven by thepowerful synthetic opioid fentanyl.

“We are in the middle of a crisis ofproportions we couldn’t have imagined even five years ago when the originalSUPPORT Act was passed,” Libby Jones, program director of the OverdosePrevention Initiative at the Global Health Advocacy Incubator, told Politico. “If they can’t pass this, it’sreally sad.”

“Community-based organizations are on thefrontlines of the overdose crisis, and the SUPPORT Act delivers crucial fundingand resources, allowing them to continue providing hands-on overdose preventioncare,” Libby Jones, the program director of the Overdose Prevention Initiativeat the Global Health Advocacy Incubator explained on a Johns Hopkins webpage. “Some of the originalprovisions in the 2018 SUPPORT Act saw modest increases, while others sawsizeable expansion of funding.”

Highlights of the SUPPORT Act include:

●     Funding for communities ofrecovery was raised by $11 million each year (from $5 million to $16 millionfor each of the fiscal years 2024 through 2028).

●     Residential treatment programs forpregnant and postpartum people saw an increase in funding of $9 million yearly(from $29,931,000 to $38,931,000 for each of the fiscal years 2024 through2028).

A few days ago, the 2018 SUPPORT Act expired,and it doesn’t look like Congress is coming to the rescue any time soon. TheHouse just restarted legislating after emerging from 22 days without a speaker.“Despite its dysfunction, the House is further along legislatively than theDemocratic-controlled Senate,” wrote Carmen Paun on Politico. “The House Energy andCommerce Committee unanimously approved a new SUPPORT Act in July. But thatmeasure’s limited ambition suggests a reason for the lack of urgency to passit.”

A bipartisan group of representatives focusedon mental health and substance use has proposed more than 70 bills to fight theoverdose crisis. Still, there hasn’t been the sense of urgency lawmakersdisplayed five years ago.

While some have hailed the SUPPORT Act as asignificant accomplishment, it has barely made a dent in the drug overdoseepidemic. “Over 100,000 deaths is not a success in this country. It’s not apolicy success,” Regina LaBelle, a former White House Office of National DrugControl Policy acting director, told Politico.

Addiction is an extremely complex diseasedriven by complicated bio-psycho-social aspects. Allocating funds to a fewgroups and organizations can only be a small part of the solution.

“When addiction epidemics strike, we want toknow why,” wrote psychiatry professor Carl Erik Fisher in his sweeping 2022analysis of the addiction crisis, The Urge. But a complex situation with amultitude of factors is too often reduced to a simplistic scenario. “What isnecessarily a complex web of intersecting forces is too often reduced to onesimplistic story: trauma, brain disease, an evil and unstoppable drug, a badpill-mill doctor, a hereditary taint, or a weak will, or poor morals.”

While certain pharmaceutical, alcohol,cannabis, and tobacco industries cannot exactly be viewed as blameless—Fisherregards many such companies as “addiction supply industries”—they are only partof the problem. “Epidemics are never caused solely by an inherent power of thedrugs themselves or the efforts of the addiction supply industries; there isoften if not always, social wounding underneath, driving the substance use.”

The combination of social disconnection,anxiety, depression, and substance misuse can expose individuals to seriousphysical and mental health risks. People with substance use disorder needcomprehensive treatment to address all relevant concerns.

Foundry Treatment Center Steamboat ChiefOperating Officer Tom Walker is well-versed in the effects of governmentpolicies and funding on population health. “Our legislators need to prioritizethe continuation of the SUPPORT Act or legislation like it to ensure thatresources exist to fight the nation’s leading cause of preventable death. Ourelected officials and government departments responsible for allocating fundsshould look carefully at the social determinants of health that lead to theastonishingly high and deeply troubling rates of mental and behavioral healthdisorders we are facing. Funding treatment is important, but understanding andstemming the underlying factors contributing to intensifying and rampantanxiety, depression, trauma, hopelessness, homelessness, and family systemdysfunction is also critical,” says Walker.

Foundry Treatment Center Steamboat operates aspecialized treatment program for men experiencing substance use andco-occurring mental health disorders. Its parent company, NRT Behavioral Health^TM,also operates intensive outpatient and telehealth services for adults inColorado and Wyoming. These programs focus on helping individuals and familiesidentify the root causes that lead to the development of substance use andco-occurring mental health disorders, learn ways to manage these issues, andreduce the stressors that perpetuate a perceived need to use substances to feelnormal or escape overwhelming distress and pain.