Consider the scale of 100,000 lives. The population of a small city. Gillette Stadium filled to 150 percent capacity. Add up annual traffic fatalities and gun deaths in the U.S., and you’re still about 10,000 people short.
This week, the government released alarming data showing that more than 100,000 people in America fatally overdosed between April 2020 and April 2021. It was the first time that drug-related deaths crested six figures in any 12-month period. Berkshire County statistics reflect this troubling trend. Opioid-related overdose deaths in the Berkshires spiked to a new record last year. Statewide, fatal opioid ODs are higher than in years past but appear to have plateaued somewhat — but not so in the Berkshires, where the overdose rate has considerably outpaced the rest of the commonwealth. In the past 10 years, the county registered increases in opioid-related overdose deaths in all but one of those years, and the jump from 2019 to 2020 amounted to a 44 percent increase.
This should be a wake-up call to the gravity of this epidemic, the worrying ways in which it is evolving and the level of failure in our current response. Many experts note that synthetic opioids like fentanyl have played an outsize role in rising overdoses, but if anything this federal data suggests that this point has been understated. In that 12-month period from April of last year to this year, synthetic opioids contributed to more overdose deaths than the number of fatal ODs caused by all drugs combined only five years ago.
The addiction epidemic, like any complex social problem, has myriad confounding factors that must be considered in an approach that grapples with the full scope of the issue and its effects. Many communities and officials across the political spectrum appear to be reaching the overdue conclusion on the efficacy of the so-called war on drugs, a campaign of little progress but considerable collateral damage disproportionately borne by vulnerable communities. But even as we come to the notion that we will not simply incarcerate our way out of this crisis, the question remains: What will we actually do about it?
We must consider the supply and the demand, and unfortunately the supply is there: The Drug Enforcement Agency said fentanyl seizures in 2021 so far have netted 12,000 pounds — that’s enough to give every American “a lethal dose,” according to the head of the DEA. More must be done to stop the influx of this dangerous drug, the majority of which finds its way here from China and, increasingly, India. But we must do more to address the demand side of the equation. That means directing funds — and reducing stigma — for addiction treatment: more inpatient beds to meet the increased need, more access to proven methods like methadone clinics and more focus on general mental and behavioral health resources for those in crisis. In the latter category, rural areas like the Berkshires are particularly underserved, which lays the groundwork for addiction and relapse.
We also must seriously consider broader and more aggressive harm-reduction measures to mitigate the brutal toll in human life exacted daily. Buprenorphine, a partial opioid agonist that is both safe and effective at suppressing opiate cravings, has shown promise in Vermont after that state decriminalized it. Massachusetts and other states should do the same.
Naloxone can reverse an opioid overdose. Unfortunately, regional advocates and federal officials alike have lamented its uneven distribution throughout the country depending on state rules and agency strategies. Given the increasing amount of overdose and other drug-related emergency calls, all first responders — EMS, police, fire — should be carrying Narcan, which can easily save a life. This is also a matter of safety for first responders themselves, who could come into contact with small but fatal doses of drugs like fentanyl or carfentanil on-scene.
A pair of bills on Beacon Hill would create a pilot program in Massachusetts for supervised injection sites, allowing people in the throes of addiction to consume drugs in a regulated facility where clean injection supplies, medical attention and access to treatment services would be available, instead of those same folks using at home alone or in an alley or park. Other countries have implemented it with some indications of success such as fewer overdoses and infections in drug users. This predictably controversial legislation has languished, but it deserves serious consideration especially given its support from legal, medical and advocacy figures alike.
Some of these measures are not cheap. Some are unpopular or politically toxic. Some are all three. Some have trade-offs that must be thoughtfully considered even in an accelerating crisis. Nevertheless, we must weigh that cost-benefit analysis against the staggering loss of life and the scant benefit of maintaining the status quo. There is no silver-bullet policy here — for problems this big, we must think bigger. The Biden administration is asking Congress for $11 billion in the 2022 budget to address the addiction epidemic. Is this enough to meet a crisis that kills 100,000 Americans annually? Is it comparable to expenditures against other problems with similar body counts? It’s likely not coincidental that we outstrip our international peers in ODs (Norway’s drug-related death rate is among the highest in Europe but less than a quarter of ours). Are they doing something — or not doing something — that we can learn from and apply here?
These grim numbers demand attention and action. The 100,000 Americans lost in a single year are not just numbers but precious human lives leaving holes in the hearts of loved ones and communities. It is morally necessary to make sure we aren’t sitting in the same place a year from now telling the families of 100,000 more Americans that it was too expensive and not politically expedient enough to do anything.