Bob Lutz: Use the data to help address overdose epidemic

By Dr. Bob Lutz

In March, Spokane City Council unanimously passed Resolution 2024-0031, “Addressing Spokane Overdoses.” It called for improved sharing of information and data to address the overdose epidemic affecting our nation and Spokane.

While graphs and numbers were important to frame the discussion, data for data’s sake is useless in affecting outcomes. Rather, the council can use this data to shape policies that could impact the health of individuals and the entire community. Context matters.

Drug use is a complex behavior impacted by an individual’s social networks, their community, and policies governing the norms of their environments. Structural or “upstream” factors – such as educational attainment, employment, poverty, discrimination and housing status – lead to social disadvantage.

Adverse childhood experiences increase the risk of substance use disorder four-fold.

These facts are reflected in the overdose data, and more broadly in health outcomes: Marginalized communities experience the worst impacts of every crisis, as discrimination and social injustice lead to poor health outcomes that are multigenerational and extend throughout an individual’s life course.

Nationally, overdose deaths have risen most years, beginning in the 1990s with prescription opioids, followed by other opioids, such as heroin, and, most recently, illicitly manufactured fentanyl, which began to increase in 2013-2014, locally in 2017-2018.

A significant increase in deaths occurred in 2020, attributed somewhat to lockdowns and other restrictions that isolated individuals with substance use disorder and made access to treatment more difficult. An estimated one overdose death occurred every five minutes in 2021; almost 108,000 Americans died of drug overdoses in 2022 and preliminary data for 2023 suggest that more than 112,000 deaths, or one death every 4½ minutes, occurred. While most overdose deaths occurred in white non-Hispanic men between the ages of 35-44, the greatest percentage rate increases have been with American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander peoples, and adults aged 65 and older. Preliminary data for Washington state suggest an overall increase of 57% since 2020, with a 14% increase between 2022 and 2023.

Acknowledging the role of social factors in the drug overdose epidemic is the first step in prevention and risk mitigation.

The science underlying substance use disorder, a recognized health condition, is well defined. Peer education and counseling, as done well by organizations like Compassionate Addiction Treatment, have been shown to be the most effective means to connect with people who use drugs.

The decadesold moral failure message and associated stigma around substance use disorder have been shown to negatively impact willingness to seek treatment because of the fear of negative social, legal and work-related outcomes. This has also been shown to lead to fewer community treatment resources and more punitive community policies.

Destigmatizing language, such as “people with substance use disorder” should replace the term “addict.” Education also extends to providers to address implicit bias that may exist so as to increase their ease with discussing substance use with their patients, and either prescribing or referring their patients to medication assisted treatment. Universal access upon request for medication assisted treatment, to include those trapped in the carceral system, can ensure people with SUD receive evidence-based, life-changing treatment, such as buprenorphine and methadone, when they are ready to do so.

Approaching prevention and mitigation through the lens of harm reduction – programs, practices and policies that meet people who use drugs where they are in a nonjudgmental fashion – is evidence-based and shown to decrease the risks associated with drug use. They include increasing access to naloxone, a life-saving treatment, safe injection and smoking supplies, and test strips for fentanyl and xylazine, the latter an adulterant increasingly being seen in the illicit drug supply. While controversial, safer drug consumption services provide supervised and safe sites for drug use that have documented success in preventing overdoses.

Irrespective of the issue, public health’s systematic approach calls upon a network of individuals and organizations that care about their community and the issues that impact the health of its citizens, especially those who are rarely at the decision-making table. While easy to generalize, stigmatize and cast blame, the data shows substance use disorder is on the street and in the home, and solutions can begin when we are able to walk miles in the shoes of every community member with SUD.

As the National Institutes of Health proclaimed: Public health is what we as a society do collectively to affect the conditions in which people can be healthy.

Bob Lutz, M.D. MPH, is a public health physician. He lives in Spokane.