Safer Solutions: Why Focusing Exclusively On Drug Supply Isn’t Enough
Our nation is now in its “fourth wave” of the overdose epidemic, and the illicit drug supply is more toxic than ever. As we continue to lose Americans to overdose, we hear a lot about reducing the supply of illicit drugs. But what about demand?
We have tools that can reduce demand for illicit drugs, but our public policies don’t always empower people to use them and may even block access to them outright. We also have tools to help people who use drugs stay alive and healthier in the face of the toxic drug market, giving people with a substance use disorder a chance to enter treatment or make healthier changes in the future.
Most people know that supply and demand are inextricably linked: When people want something, markets (both legal and illegal) will find a way to get it to them. Those market forces are part of why fentanyl seems to be everywhere. It’s cheap, extremely potent, and easy to smuggle. In 2023, almost 75,000 of the 80,719 opioid overdose deaths in the United States involved fentanyl. While interrupting supply is important, we know fentanyl will continue to find its way into the country via smuggling and even shipping the drug or its ingredients. A singular focus on suppressing supply ignores the equal importance of reducing demand.
Tools to Reduce Demand for Illicit Drugs
Methadone (particularly effective in the era of fentanyl) and buprenorphine are “gold standard” medicines to treat opioid addiction—in fact, they can quadruple people’s likelihood to stay in treatment and reduce overdose deaths by nearly 60 percent. This equates to a serious reduction in demand; however, Americans don’t have adequate access to either medicine.
Although the Drug Enforcement Administration (DEA) recently announced permanent flexibilities for telehealth prescribing of buprenorphine, it remains underprescribed. Barriers like stigma, cost and fear of attracting DEA attention play a role in keeping buprenorphine (often referred to by the brand name Suboxone) out of the hands of many people who need it. Meanwhile, methadone is the most regulated medicine in the United States. It cannot be prescribed via traditional channels, and it is inaccessible to millions who might benefit from it. Reforms to this overregulation could begin to unshackle methadone from its regulatory prison.
Another way to reduce demand lies in a surprising place: syringe services programs (SSPs). Most Americans know these programs as “needle exchanges” because they offer sterile syringes to people who inject drugs in order to prevent HIV and hepatitis C. SSPs are sometimes maligned as “encouraging” drug use, but they are actually proven to help reduce drug use and are one of the most effective ways to connect people to treatment. SSP participants are five times more likely to enter treatment and three times more likely to stop using drugs. Compassionate care and wraparound services help SSP staff build trust with participants, which in turn creates opportunities to help people enter treatment when they’re ready for it. A number of holdout states prevent SSPs from operating within their borders, but proposals like Nebraska’s LB 165 could help change that.
Tools to Keep People Alive
Even if we take steps toward reducing both supply and demand, millions of Americans will still use illicit drugs every year, whether occasionally or habitually. The reality is that some Americans cannot or will not “just say no.” We should confront that reality with pragmatism. If we care about giving people a chance to pursue a healthier path in life, then they need tools to stay alive when they do use drugs.
Drug-checking equipment allows people to test drugs for adulterants like fentanyl to reduce their risk of overdose. Georgia and Virginia passed bills this year to improve existing drug-checking laws. A few states still criminalize such tools; however, Texas is currently considering a bill that would unlock access to some drug-checking equipment.
Medication to reverse opioid overdose can also save lives. We need naloxone (often referred to by the brand name Narcan) to be more accessible in retail settings and workplaces, and we need to get it into the hands of people who use drugs. States with laws that encourage naloxone use have seen a 14 percent drop in overdose deaths.
Conclusion
The opioid crisis is complex. Supply-side-only interventions over the last 50 years have failed to curtail drug use and overdose deaths. We need an all-hands approach to address demand and safety alongside supply (as well as prevention, which is beyond our word count here). There are many tools for doing so, but we aren’t using them to their full advantage. Smart policies that unlock access to these tools can reduce demand for illicit drugs and give people a fighting chance at life and better health.