More Action Needed to Curb Overdose Deaths, Administration Says

WASHINGTON — The Biden administration on Wednesday released model legislation to help states improve access to naloxone treatment for opioid overdoses as the U.S. reached a grim milestone in drug overdose deaths.

Research shows that implementing the model law “could have a significant impact on lowering drug overdoses and increasing quality of life. I believe no one should die of an overdose simply because they didn’t have access to naloxone,” said Rahul Gupta, MD, MPH, the administration’s Director of National Drug Control Policy, during a press briefing. “But sadly, today that is happening across the country, and access to naloxone often depends a great deal on where you live. This, like any overdose reversal drug, must be made available for everyone who is at risk of an opioid-related overdose.”

“This model law can help all states implement consistent, evidence-based policies to make naloxone always accessible to those who need it,” Gupta said. “We certainly hope that state leaders will carefully consider this model law, which can help save lives.”

The model law encourages citizens to obtain emergency opioid antagonists such as naloxone; protects individuals administering opioid antagonists such as naloxone from unfair prosecution; requires health insurance to cover naloxone; and provides increased access to opioid antagonists in educational institutions and correctional settings, among other provisions. Its creation was funded by the White House Office of National Drug Control Policy.

Passing the 100,000 Mark

The model law’s release comes in the wake of a sobering statistic: The CDC announced Wednesday that an estimated 103,000 Americans have died from a drug overdose in the 12 months ending in April 2021. “This translates to an American perishing from a drug overdose death every 5 minutes,” Gupta said. “Crossing this solemn mark in a 12-month period places this nation at an inflection point in the overdose epidemic. This is unacceptable and it requires an unprecedented response.”

That figure is “game-changing …. a more than 28% increase in deaths from overdoses just from the previous year,” said Health and Human Services (HHS) Secretary Xavier Becerra, who was also on the press briefing call. “Here at HHS, we decided to come up with a new preventative overdose strategy. And I think what we’re trying to do is say to the world, ‘It’s not just a matter of tackling the drug use disorder; it’s about preventing anyone from dying from an overdose.'”

“The new strategy consists of four priorities: primary prevention, harm reduction — which I believe is somewhat novel for the federal government — evidence-based treatment, and recovery support,” he said, adding that regarding the last priority, “We’re not going to let you go, once we catch it and save you; we’re going to stay there with you, shoulder to shoulder, to make sure you continue forward in your efforts to try to right your life.”

The administration has already started acting on some of these priorities, including removing barriers to prescribing opioid use disorder treatments and “providing real resources that are needed to prevent, treat, and make sure folks recover,” he added, noting that the president has proposed $11 billion for these programs in the 2022 budget, almost $4 billion more than the previous fiscal year. “This crisis seems to be getting worse; we need all hands on deck, and that’s the approach we’re taking at HHS.”

Harm Reduction Strategies Outlined

During a question-and-answer session, MedPage Today asked officials to elaborate more on what was being done in the area of harm reduction, including any support for safe injection sites, a strategy that several states and cities are starting to experiment with. Gupta mentioned increasing access to naloxone as well as “syringe services” programs, otherwise known as needle exchange programs. “It’s going to be very important for us to make sure that those are appropriately resourced and available to people in order to prevent not only the outbreak of clinical diseases, but also be able to meet people where they are and help them,” he said

A third harm reduction strategy is providing fentanyl test strips, Gupta said. “The reason that’s important is because of the prevailing supply in both counterfeit pills as well as generally the rise in deaths that are happening … It’s really important for Americans to themselves be able to have the ability to make sure that they can test for fentanyl in their substances to ensure that they are not subjecting themselves to potentially fatal risks.”

As for safe injection sites, Gupta said he couldn’t discuss that issue “because of ongoing litigation.” He likely was referring to a federal case known as United States v. Safehouse, in which a nonprofit group in Philadelphia tried to open a safe injection site but was blocked by the Trump administration, which argued that the site violated a 1980s law prohibiting the opening of any facility for the purpose of using illegal drugs. Last month, the Supreme Court declined to review an appeal of a lower-court decision that went against the nonprofit group.

More Addictive and More Lethal

Miriam Delphin-Rittmon, PhD, Assistant Secretary for Mental Health and Substance Use, said that the Substance Abuse and Mental Health Services Administration is considering keeping some COVID-related rules allowing for take-home methadone treatment. “Data has shown that offering this flexibility has been effective for those in opioid treatment programs,” she said. “At the same time we must ensure that addiction resources are directed towards communities that need them most … For example, we know that the rate of overdose deaths among African Americans [is] growing faster than other communities across the country.”

“We also recognize that treatment alone is insufficient to ensure long-term recovery,” Delphin-Rittmon added. “That’s why we remain focused on increasing funding for recovery support, as well as training additional workforce for peer, employment, and housing support.”

Nora Volkow, MD, director of the National Institute on Drug Abuse, said that the increase in overdose deaths is driven both by fentanyl and by synthetic analogues to fentanyl, as well as methamphetamine, and “these patterns are going to continue. Why? Because these drugs are among the most addictive that we know of, and they’re also the most lethal.”

At the same time, these drugs also appear to be more profitable for the illicit market than drugs that require cultivation, like heroin and cocaine, Volkow said. And even though naloxone is effective, “it is harder to actually implement in someone overdosing from fentanyl than from heroin, not just because it’s a much more potent drug but also because it gets into the brain extremely rapidly, leading to stopping of respiration and death.” Scientists are working on solutions to overcome these problems, she said.