More than two decades after drug overdose deaths began their nearly uninterrupted rise, the inability of the United States to stunt the growth in any way is beyond frustrating.

But it’s hard to call it surprising. The harsh truth is that the public health response still is not enough to overcome a roaring epidemic that is changing and growing in strength, largely because too many Americans reject the proven public health methods that can be used to reduce overdoses and prevent other poor outcomes.

Still, across the nation, only a fraction of the people with substance use disorder have any sort of help available to them. And only a fraction of the people who get help get it in the form of medication-assisted treatment, the use of prescription drugs such as buprenorphine or methadone to quell the physical need for opioids to allow the patient to address other problems and get back to leading their normal life — shown to be the most effective way to treat opioid addiction.

There is also still widespread opposition to the use of harm reduction. Needle exchanges, for example, not only prevent the spread of fatal and otherwise costly diseases like AIDS and hepatitis C, which have been surging in Maine and elsewhere, they also help connect people with various health and addiction resources. Safe injection sites are roundly opposed.

Also, availability and use of the overdose-reversing drug naloxone varies widely state to state and region to region. Some police departments, for example, have every officer carry it, while others refuse to.

Maine in a lot of ways has been heading in the right direction. Because of cuts to Medicaid and a constitutional objection to drug treatment during the LePage administration, medication-assisted therapy was hard to come by. Distribution of naloxone was discouraged.

Now, Maine has expanded Medicaid, allowing more people to access treatment for substance abuse and mental health issues. There has been an effort by the Mills administration to get more doctors to prescribe buprenorphine. Naloxone is more widely carried.

But fatal overdoses still increased here. Just like the rest of the country, the increase can be blamed on the powerful opioid fentanyl, often used in fatal combination now with stimulants.

The pandemic, too, is making things worse, isolating people further and disrupting the already chaotic treatment system.

But while some of the factors driving the increase in overdoses are new, the problems with the country’s response in general have stayed largely the same. While access to the best kinds of treatment is getting better, it’s not nearly enough to meet the demand.

And while hundreds of thousands of Americans wait for treatment, the country has done too little to mitigate the worst effects of their drug use. Too little is being done to prevent overdoses or to stop them once they occur.

Too many people still go to jail or prison as a result of nothing more than their addiction.

Too often, people with substance use disorder are still treated as pariahs, not patients needing care. Until that changes, we shouldn’t be surprised that addiction remains such a problem.


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