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Bioethics Forum Essay

We Can’t Forget the Nation’s Other Epidemic

In 2018, drug overdose mortality declined for the first time in over two decades. Not much, mind you (about 4%), but it was at least a pause from the long, seemingly-inexorable march upward. Preliminary data from the Centers for Disease Control and Prevention, however, has shown something very disconcerting: that the tiny bit of progress from 2018 was wiped out in 2019, as drug overdose deaths again climbed to over 70,000.

And that was before Covid-19.

The Covid-19 pandemic threatens to harm efforts to reduce drug overdose deaths in two ways: mundanely—as with practically every other issue in the world right now—by simply overshadowing it; but worse, by exacerbating it. Not only is it difficult to remember and focus on long-standing public health threats like drug overdose during a once-in-a-century infectious disease outbreak, but our response to Covid-19 is actually worsening the drug crisis in America.

Although it’s understandable that we’re consumed by Covid-19 now, given the degree to which it has brought the world to its knees, we can’t forget that many other public health threats still exist. Drug overdose has killed more than 770,000 people over the past two decades, and no end is in sight. Unlike in the case of Covid, there will be no vaccine for addiction (despite the fact that a pharmacological treatment under investigation is popularly called an “addiction vaccine”—this is a misnomer); there will be no herd immunity; and there is no realistic possibility that in the coming months or years we will develop a medicine that rescues the population. And we are not dedicating anything like the same level of resources to addiction and overdose as we are to developing vaccines and therapeutics for Covid-19.

In short: while Covid is scary, there is a chance (and a fervent hope) that we will solve this problem in the relatively near future. That is not in the cards for the country’s problem with drugs.

Worse, however, is that Covid isn’t merely overshadowing the overdose crisis—it’s directly worsening it. This was entirely predictable (and predicted), as our primary tool for fighting Covid-19 is social distancing. But social distancing is incredibly problematic for those who use drugs or who are in recovery. Access to treatment and community groups has been disrupted, and the recommendation to stay away from others is in direct tension with the harm reduction principle never to use alone. Further, the pandemic is strengthening the reasons people have to use drugs, which include loneliness, hopelessness, unemployment, poverty, and a general desire to escape. It should surprise no one that a terrifying disease and soaring unemployment have led to more drug use. Preliminary reports from many states paint a disturbing preview of what this year’s overdose mortality data will look like.

In this month’s issue of the Hastings Center Report, I and several others discuss the ethical issues surrounding America’s drug overdose crisis. Obviously, we began working on these pieces before Covid-19 was dominating our lives, and I understand if the problems we raise feel a bit like last year’s problems now. But they’re not. They’re the problems of last year, this year, next year, and—in all likelihood—the next decade. We do not, therefore, have the luxury of ignoring them while we are preoccupied.

We are still in crisis when it comes to drugs in America, and it’s a crisis for which it has been very difficult to garner attention, resources, and empathy. We must not allow Covid-19 to derail what precious little progress has been made.

Travis N. Rieder, PhD, is a research scholar at the Johns Hopkins Berman Institute of Bioethics, Twitter: @TNREthx. He is the author of In Pain: A Bioethicist’s Personal Struggle with Opioids.


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