The Opioid Crisis Will Be With Us For Decades: Lessons From D.C.

D.C. offers a sobering lesson about just how long a drug addiction crisis lasts in a community (boldface mine):

While other jurisdictions across the country grapple with opioid overdoses among their white residents, the District offers a unique perspective. The majority of opioid-related deaths in the city fit a select profile: male, between ages 50-59, and black, according to a 2017 report from the D.C. Office of the Chief Medical Examiner….

Historians trace its presence in D.C. as far back as the late 1930s, and by the 1960s heroin addiction reached epidemic status in the city. During that epidemic, a young Harvard-trained psychiatrist named Dr. Robert DuPont was working in the D.C. Department of Corrections. He found that nearly half of the men who came into the D.C. jail between 1968 and 1970 tested positive for heroin

In 1972, DuPont authored a report titled “Where Does One Run When He’s Already in the Promised Land,” referring to people who had escaped the Jim Crow South for northern cities. He found that 13.5 percent of males born in the District in 1953 were addicted to heroin, that in “large sections of Washington” the addiction rates were double that, and that addiction was concentrated among young, lower class black men.

The heart of the heroin epidemic in the 1970s was in a population of people who were born between 1945 and 1957. That group is the group that is now aging,” says DuPont. “The teenagers of the 70s have become 50 and 60 year olds. I’m amazed at the the tenacity of the problem.”

…“These gentlemen who have been using for many years are teetering on this line of safety,” says Dr. Tanya A. Royster, Director of D.C.’s Department of Behavioral Health. “They know how much to use. They know when to use. They know where to get it.

“Now that these new things are introduced into the opioid supply, like fentanyl and some of the other synthetics, they are much more lethal and much more deadly. So what they have been doing for the last 20 or 30 years is not necessarily safe. That’s our message to them: What you’ve been doing isn’t working anymore because the supply has changed.”

Changes in supply can be lethal, though political pressures, such as ‘getting tough’, often lead to these changes.

D.C.’s experience also means we’re going to have to take harm reduction, and not just ending addiction seriously:

The Department of Behavioral Health has had its eyes on this problem for a long time, setting up prevention centers across the city and hotline numbers. Royster’s goal is to reach the users before fentanyl does. “We have two approaches to recovery,” she says. “One is abstinence, which is: Stop using or don’t start using drugs. The other is harm reduction. If you’re going to use a drug, use it in the safest, least harmful way—trying to reduce the amount of damage. So we try to make sure you have good healthcare. We make sure you have clean needles.

“Many of the the older black men are in the harm reduction category. We know that they’ve been using for a long time. They have been very clear that at this point in their lives, or at no point in their lives, have they been willing to stop using. So the strategy is, how do we keep them healthy and alive while we continue to encourage and support treatment?

Harm reduction is a controversial option. It involves supplying addicts with clean needles for drug use and methadone, an opioid medication, to reduce withdrawal symptoms. Abstinence supporters say that this approach is complicit and counterproductive, while harm reduction advocates argue that it is a more effective method to treat addiction and that it decreases the rates of other comorbidities such as HIV and Hepatitis C infection.

The consequences of opioid addiction likely will be with us for decades, and no one seems to realize this.

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