August 31 is International Overdose Awareness Day. Here’s how to commemorate it.
Nearly 200 health awareness days, weeks, and months are on the US National Health Observances calendar, and more than 145 awareness day bills have been introduced in Congress since 2005. It seems like every couple of days, another awareness day is upon us.
But very few come with the jolt, or the urgency, as International Overdose Awareness Day on August 31.
IOAD was started in 2001 by Sally J. Finn at the Salvation Army in St. Kilda, Melbourne, Australia. According to the Penington Institute, the not-for-profit Australian public health organization that coordinates the day of awareness, it is “the world’s largest annual campaign to end overdose, remember without stigma those who have died, and acknowledge the grief of the family and friends left behind.”
Any recipe for change of the scale needed to end an epidemic (overdose deaths, deaths of despair) requires awareness as a necessary first step, but awareness alone is not enough. You need so much more.
You need the spirit and action that animate International Overdose Awareness Day.
As the CEO and Chief Medical Officer at SunCloud Health, I know firsthand that overdose awareness only goes so far. First there needs to be Awareness. Then Acceptance (the opposite of stigma). Then informed and effective Action. That’s how meaningful change happens.
Over 100,000 Americans died from drug overdoses last year, the vast majority from opioids. Despite the broad scale public health awareness campaign for what we call the Opioid Epidemic, the number of people overdosing continues to rise. To turn that tragic trajectory around, our awareness must be accompanied by acceptance and action. And it needs to be personal.
In the spirit of “active awareness,” to properly commemorate International Overdose Awareness Day, let’s look closely at data recently published by the Centers for Disease Control in Atlanta. The findings are alarming and demand our awareness—and yes our acceptance and our action.
Study finding #1
The drug overdose rate increased by 30% among all demographic groups from 2019 to 2020, the most recent years that data was available. The increase was driven largely by fentanyl and fentanyl analogs.
Be aware of this: Addiction is a killer. Addiction involving drugs and pills laced with fentanyl is a quick and decisive killer. Fentanyl is a highly potent synthetic opioid that is 100 times more powerful than morphine. Its danger comes from its capacity to suppress our respiratory drive, even when a small quantity is ingested.
This lethality is especially present if a person is “opioid naïve” or just getting out of a controlled setting (rehab, hospital, prison, etc.) where they had no access to opioids. Same goes for people in addiction treatment who have been taking a medication such as naltrexone or Vivitrol that blocks the opiate receptors. If or when they stop this medication, their bodies are much more sensitive to opiates if they start using again.
In these instances, a person’s brain and body loses its tolerance to opioids, so even small amounts that once would have been tolerated can kill.
Oftentimes people aren’t aware that fentanyl is in counterfeit pills or laced into other substances like cocaine, methamphetamines, even weed. When a person who is using these drugs doesn’t know they contain fentanyl—and many times they don’t—it can be deadly, especially if that person has not developed tolerance to opioids.
Study finding #2
The overdose rate was 44 percent higher among Black Americans and 39 percent higher among Native Americans/Alaskan Natives than for non-hispanic Whites.
Be aware of this: For all sorts of reasons (including lack of access to care, implicit bias in medical providers, systemic racism in medical training and healthcare organizations), Black people who get treated for addiction are less likely to receive suboxone, a proven medication for opioid use disorder (OUD). For that matter, Black Americans are less likely to receive substance use disorder treatment of any kind.
Again, the reasons for this are many. Much of medical care, psychiatric care, and addiction care have been culturally out of tune. Stigma around addiction and psychiatric treatment carries a heavier weight in Black communities, who have historically had less access to such care. Also, for justifiable reasons, Black communities have a long-standing mistrust of the medical establishment (abhorrent case in point: the Tuskegee Study of Untreated Syphilis in the Negro Male which ended only in 1972).
Further, the link from primary care or the emergency room to addiction services is limited or nonexistent. Many times, you have highly under-resourced hospitals and clinics operating in highly under-resourced communities. This leads to less education about addiction and addiction treatment among family, friends, and community members, and lower awareness/usage of harm reduction strategies like needle exchanges, fentanyl test strips, Narcan, and so on.
Study finding #3
The greater the income equality in the counties/locales included in the study, the higher the overdose rate, especially among Blacks versus Hispanics and Whites.
Be aware of this: These kinds of extremes are often a sign of social illness. Whereas balance is usually a sign of health. In communities with large income inequality, you have increased minority stress and less community cohesiveness. You also tend to see much better mental health/addiction care for people with private insurance or who can pay out of pocket than for those who are economically disadvantaged and rely on Medicaid/Medicare for healthcare.
A big part of this disparity in care is based on the different reimbursement rates for addiction treatment providers. Medicaid reimbursements are often a fraction of what private insurance pays providers, for example $40-80 (Medicaid) versus $300 (private insurance) for three hours of intensive outpatient (IOP) care. No surprise, therefore, that the care received is lower in quality when reimbursement rates are low. No surprise also that many addiction treatment providers decide not to take Medicaid/Medicare to begin with.
Study finding #4
Black men over 65 years old had seven times the overdose rate as their White peers.
Be aware of this: Again, some of this may represent mistrust of the medical establishment and lack of cultural competency of white physicians and healthcare providers. It’s also about a fragmented medical system that is terrible at identifying addiction often until someone is older, sicker, and in the advanced stages of addiction. Preventive care is essentially nonexistent in addiction treatment. Early identification (pre-addiction interventions) is also virtually nonexistent.
Study finding #5
In many areas of the country where substance use treatment is available, it is significantly underutilized.
Be aware of this: Often there are longstanding religious and cultural barriers to getting treatment.
There’s a history of neglect by the predominantly white medical community (in training, research, policy, and direct care). Providers are often unable to educate people because we don’t meet them where they are. In the case of many communities or color, we don’t meet people in their own communities by using their language and by benefitting from their belief systems. Often we don’t take the time, haven’t had the training, and don’t make the effort to care enough to know how to speak to each other and heal each other in meaningful ways.
Based on the study findings and from my own experiences, it’s clear we need to do a far better job of using culturally attuned approaches to harm reduction, patient education, research, and direct patient care. We need to use plain language to describe addiction as a brain disease with biological, emotional, social, and spiritual manifestations. We need to make it clear that recovery is multi-faceted and includes spirituality, medication, therapy, and family and (importantly) community support.
People who are considering or seeking treatment don’t want to be judged for their religious, spiritual, or cultural beliefs. Too often, providers have an air of superiority, an attitude towards religious beliefs or spirituality that comes across as “that’s crazy or childlike thinking…you poor uneducated person…just take this medicine and it will be all better.” Then we wonder why the patient won’t take the proverbial medicine.
Back to International Overdose Awareness Day in 2022.
From all reports, the number of people dying from drug overdoses is continuing to spike this year. But it doesn’t have to be like this, and it’s not something we should feel helpless about. It is something we can take action around.
First, we need to remember that being aware that people are overdosing is only the first step. Hopefully we can then take action on that awareness. Informed action that accepts the stark reality of the current state of affairs.
What form might that action take for lay people? My advice is to keep it simple, look close to home, and take action now.
For example, do you know someone who has had addiction in the past, or does now? Do you have a friend or family member who is struggling with their mental health or trauma and uses alcohol or drugs to cope?
Do you know someone—maybe your spouse or parent—who is on prescription pain medication for poorly controlled pain and wants relief? Maybe you know a person who may be looking online for alternatives to what their doctor is prescribing them? Maybe you have old prescription bottles of opioids in your medicine cabinet?
Here’s my advice: If a friend or loved one is dealing with any of those scenarios, reach out to them today. Call, text, email, or go visit in person, and ask how they’re doing. Try to listen, and be willing to help if they ask for it.
If a loved one takes prescriber or illicit opioids, ask your doctor or pharmacist about how you can get Narcan (suboxone) so you’re prepared in case of an overdose. If you or a loved one have leftover prescriptions, take them to a pharmacy for disposal.
Celebrate someone who is currently in treatment for addiction. Celebrate someone who has been sober for 2 months or 2 years or 20 years. Celebrate the life of someone we have lost to this staggering death toll of overdose deaths.
Consider taking action in all these ways, to commemorate International Overdose Awareness Day.
It may end up saving a person’s life—and improving the quality of yours.