As Overdose Deaths Soar, White House Announces Harm Reduction Program

With opioid-driven drug overdoses reaching record levels, the White House is turning away from punishment and toward treatment.

An altered supply and lack of reliable support networks have driven U.S. drug users to overdose at record rates.

There were 100,306 confirmed drug overdoses between April 2020 and April 2021, according to CDC's National Center for Health Statistics, an average of 274 overdose deaths per day.

In response, on Monday White House and Health and Human Services officials announced the first-ever Substance Abuse and Mental Health Services Administration Harm Reduction grant program, set to provide $30 million to fund harm reduction programs throughout the United States.

"It's about moving people further along in terms of stages of change," HHS Assistant Secretary for Mental Health and Substance Use Dr. Miriam E. Delphin-Rittmon told Newsweek. "It's planting valuable seeds that can make a difference and help people move into long-term recovery by connecting them to services and support."

While stigmas around overdoses and addiction have traditionally been placed on individual users in the U.S., Dr. Sheila Vakharia, deputy director of the Department of Research and Academic Engagement from the National Drug Policy Alliance, says the issue goes far beyond that.

"It's the drug supply that's killing people, not their addictions," she told Newsweek. "Addiction doesn't have to result in death. It's when you're using a toxic drug supply that this death is more likely."

Last year, some 75,673 deaths were due to opioids, making up almost 75% of the total number of overdose deaths.

By far, the most dangerous opioid is fentanyl. Vakharia said widespread abuse of the drug started on the East Coast, and has spread rapidly throughout the United States.

"This drug is 50 times more potent than heroin," said Dr. Nora Volkow, Director of the National Institute on Drug Abuse. "That means you need 1/50 of the volume of fentanyl that you would need with heroin."

"With drugs like fentanyl I might be dead were I a user today," said Stephen DellaValle, who recovered from his own addictions and previously served as president of the board for Turning Point New Jersey, the state's premiere addiction treatment center.

"The stuff on the street today is so much stronger than it used to be," he added.

DellaValle told Newsweek about his personal battle with addiction in the 1980s, sharing how his illness drove him to lose friends, relatives and a successful career, ultimately landing him in jail.

"Drugs destroyed me, he said. "I was in the grip of it. I didn't want to use it, but I did."

"Nobody wakes up wanting to be an addict, use drugs every day and lose everything," he added. "What most people do not understand about drug addiction is just how consuming it is."

Despite having practical reasons not to use, such as family or a career, people who are addicted or have formed dependency to drugs have physical symptoms which makes it harder to stop using, said Dr. Volkow.

"If you're given an opioid, you will rapidly develop physical dependence," she said. "The cells in your body adapt to the drug by down-regulating the systems that the drugs are stimulating, trying to balance it. So when the drug is removed, you have these horrible symptoms, and the more you have been on that opioid, the more severe those symptoms."

While law enforcement has tried to curb the usage of illicit drugs for years, in an odd twist, the more law enforcement cracks down on illegal drugs, the more potent they become — a phenomenon known as "the iron rule of prohibition."

Vakharia said the problem accelerated after 1999, when state governments began making opioids significantly harder for doctors to prescribe. These changes drastically limited supply, pushing those who previously used those medications, and may have already formed dependence, to find comparable, more accessible alternatives.

In another odd twist, the system designed to treat the crisis was actually fueling it.

"The opiate crisis was actually triggered by the healthcare system," said Dr. Volkow.

The laws of supply and demand took over, with devastating effect.

"People were still physiologically dependent but had no regular supply, so they started turning to the underground market," Vakharia said. "It got harder for there to be enough pills in circulation, and suppliers realized that heroin is a lot cheaper than having to buy a pill."

"So people started buying and selling heroin on the street, who maybe didn't before," she added.

As law enforcement cracked down on opioid prescriptions and heroin sales, drug manufacturers and suppliers changed their strategy.

"The dealers had to get smarter. They could not keep up with rising demand and were losing a lot of supply on the streets, so they started taking creative means," Vakharia said. "They discovered that by using commercially available chemicals, they could make a drug called fentanyl, which acts like heroin or a prescription opioid in the brain, but is a lot more potent."

The low-cost production of fentanyl allowed dealers and drug organizations to expand their profit margins and avoid scrutiny from law enforcement agents looking specifically for heroin and prescription opioids.

"To carry a few bricks of heroin over the border and bring it in is not very discreet, because you need a lot of it," she said. "But with fentanyl, you could pack one brick and that's enough. If you cut it with other adulterants or products, you could make a little bit go a long way."

The evolving nature of drug manufacturing is a major concern for the Drug Enforcement Agency, which recently issued a public safety alert on the issue of overdoses, its first such alert in six years.

"DEA's Public Safety Alert seeks to raise public awareness of a significant nationwide surge in counterfeit pills that are mass-produced by criminal drug networks in labs, deceptively marketed as legitimate prescription pills, and are killing unsuspecting Americans at an unprecedented rate," the department wrote in a recent statement.

And while law enforcement does its best to crack down on the sale of fentanyl, the true threat is faced by the consumer, who often has limited information about where their drugs came from, how they were manufactured, and what ingredients were used to make them.

"When fentanyl started getting cut into the drug supply, it's not like the users got any sort of overt headline or announcement, '' Vakharia said. "Users started buying the regular quantity that they were used to buying, not realizing that fentanyl was in it."

"Suddenly, people were overdosing because they were accidentally taking more than they anticipated," she added.

Vakharia argues that in order to properly confront the issue, empathetic solutions must be offered on the local, state and federal level. Turning Point New Jersey has been addressing this issue, at a local level, for decades.

"With so much trauma and PTSD, there are many underlying reasons why people use drugs and drink alcohol," DellaValle said. "And if these underlying problems aren't addressed, most of the time these clients are not going to stay clean and sober."

The non-profit organization provides dual-diagnosis treatment services, including residential opportunities, managed drug detoxes and rehabilitation programs. It has helped thousands in the state, and serves more than 4,000 people every year.

"Our mission here is to help people that can't (yet) help themselves," said DellaValle, who currently serves as a manager with Turning Point's Admissions Department.

He also spoke on the importance of support systems not only for his patients, but in his own journey to recovery. He started drinking alcohol in his early teenage years, and he said by his 20s he was addicted to drugs, including heroin.

"I grew up in Newark in a really tough section where, if you were not tough, you did not survive," DellaValle told Newsweek. "It was very scary, but I couldn't show that I was afraid. Instead, I drank alcohol at a young age, which progressed into other drugs."

Now approaching his 33rd year of sobriety, he said his life was saved by the support and empathy of loved ones.

"My wife's support is ultimately what saved my life," DellaValle said, "because she supported me without enabling me."

Noting the importance of this kind of support, Dr. Delphin-Rittmon said, "it's important for people who are struggling to know that they are not alone and that recovery is real and possible."

In addition to personal support networks, Vakharia also advocates for the nationwide decriminalization of narcotics. She noted the progress her organization has seen in urging states like Oregon to decriminalize.

"Addiction is the only health issue that is a crime," she said. "As long as drugs remain illegal, people who are addicted to them are de facto criminals for engaging in the very behavior associated with their health issue."

"Because we believe it's a health issue, we should decriminalize drugs," Vakharia added, "and then reinvest hundreds of millions of dollars into making a more robust addiction treatment system."

These calls have gained traction in states like New York. After experiencing more than 2,900 opioid overdose deaths in 2020, officials announced last week that it would be opening the nation's first two supervised drug-injection sites.

Volkow sees this as a milestone.

"I am optimistic because these programs have existed in many places in the world," she said. "The sites have shown that they decrease mortality from overdoses. They have also been able to use these sites to reach out to patients so that when they are ready for treatment, they can facilitate that transition."

Dr. Delphin-Rittmon said that organizations that operate harm reduction programs like these will be able to apply to the new SAMHSA grant and receive funding from the federal government to help with operations.

"This is the first time that an award specifically dedicated to harm reduction in the millions has been awarded by the government,'' she said.

"There are people all across the country who are living and thriving in recovery," Delphin-Rittmon said. "There's a rich, vibrant recovery community that is ready and willing to embrace anybody that is struggling."

"So, the time is now to make a difference," she added.