July 24, 2021

2020’s Pandemic Within a Pandemic: The Opioid Crisis


Dear PERF Members,

On Wednesday, a group of state attorneys general announced they had reached a $26 billion settlement with  Johnson & Johnson and three pharmaceutical distribution companies over opioid painkillers.

This settlement came one week after the CDC reported that more than 93,000 people died of drug overdoses in the United States in 2020. That’s a 29% increase over the 72,000 who died in 2019. To put that number in context, it’s higher than the number of Americans who died in 2019 due to motor vehicle crashes (37,595) and firearms (39,707) combined.

It’s hard to understand how nearly 100,000 deaths could fly under our national radar, but it’s happening. This story has gotten little attention, because it’s been overshadowed by the COVID-19 pandemic.

But what’s really happening is that we have a pandemic within a pandemic.  The drug overdose crisis, driven by deaths from fentanyl and other opioids, got much worse in 2020 partly because of COVID.  To reduce COVID infections in jails, thousands of inmates were released early, including many with histories of addiction. But drug treatment programs, like everything else, had to be scaled back to reduce COVID infections. The social isolation and economic hardships resulting from COVID may also have contributed to increased drug abuse and overdoses.  

Meanwhile, drug dealers weren’t practicing social distancing, so drug activity continued on the streets, which may be part of why we’re seeing increases in violent crime related to drug activity in some of our urban areas. The economics of fentanyl are that it’s a fraction of the cost of heroin, which makes it more affordable while it’s also far more lethal.

A little background information: 

Overdose deaths have been increasing for more than two decades, with a particularly sharp increase since 2015.

Source: New York Times

It’s happening almost everywhere.  Last year, overdose deaths increased in every state except New Hampshire and South Dakota.

Source: CDC

Synthetic opioids (primarily fentanyl) have been driving this spike.

Source: NIDA

PERF’s members have been on the front lines of this crisis for years.

Because police are often the first responders to 911 calls about drug overdoses, years ago they started carrying nasal spray versions of naloxone, the life-saving drug that can reverse a drug overdose within seconds. Police have saved thousands of lives with this one simple change in policy and procedure. And in some police departments, providing naloxone is just a first step. The day after a near-fatal overdose, police officers, working closely with treatment providers, follow up and offer treatment services to the person who overdosed.

It’s really astonishing how the role of the police in this area has evolved. Instead of arresting people with addictions, cops are saving lives by using naloxone and/or diverting them into treatment. At a time when police are heavily criticized, we have this remarkable story about cops taking on public health roles. We talk about the sanctity of human life, and this is a prime example of that. It needs to be celebrated in some way, because saving lives humanizes police in a way the public doesn’t always see. 

Details about all of this can be found in 4 major PERF reports:

Our most recent report, Policing on the Front Lines of the Opioid Crisis, outlines the three roles that police have in responding to the opioid crisis: emergency response, public safety, and law enforcement.

Importantly, there is a role for prosecuting people who traffic in fentanyl. We see a distinction between treating addicted persons from a health perspective, while prosecuting drug traffickers who dispense fentanyl, which is the reason people are overdosing in record numbers.

Our new report identifies five strategies that police can adopt to serve all of their roles:

  1. Signal to the public that the local police are interested in helping the victims of opioid abuse and arresting those who are doing them harm.
  2. Develop relationships and maintain communications with opioid users after they have had an opioid-related encounter with the police.
  3. Inside the department, designate an individual or a team to focus on understanding how the department is responding to opioid cases.
  4. Outside the department, participate in multiagency and cross-disciplinary collaborations to develop new response options and make more efficient use of limited resources.
  5. Ensure that officers understand how opioids affect a person’s body and mind.

Many agencies are already implementing some or all of these strategies. Whether you have a well-established opioid-response strategy or are working to get a handle on the issue, I strongly recommend reviewing this timely report.

Reducing overdose deaths will require the coordinated involvement of police, drug treatment officials, and others at the federal, state, and local levels. President Biden’s nominee for the Office of National Drug Control Policy, Dr. Rahul Gupta, took a data-driven approach to this issue while serving as public health commissioner in West Virginia, one of the states hardest hit by the opioid epidemic. 

New strategies are being tried at the state level. Two weeks ago, Rhode Island became the first state to approve supervised drug consumption centers, where drug users can take their drugs in a place where someone is looking out for their well-being and can connect them with addiction treatment and other social services. (A police inspector from Vancouver, BC, which has had a similar site since 2003, shared his agency’s experience on page 62 of PERF’s 2017 report on the opioid crisis.)

I’d like to close by recommending a few recent examinations of how the opioid crisis developed. HBO’s two-part documentary on this topic, The Crime of the Century, explores how pharmaceutical companies profited from this epidemic, with no regard for the safety of their product or the well-being (or survival) of their customers. Patrick Radden Keefe’s book Empire of Pain takes a deeper dive into the history of the Sackler family, who founded Purdue Pharma. And Dopesick by Beth Macy, a former reporter for the Roanoke Times in Virginia, profiles those on the front lines of this epidemic, particularly in Appalachia.

In a year when we’ve rightfully celebrated the countless lives saved due to the pharmaceutical industry’s innovative vaccine development, these books and documentaries are infuriating reminders of the avoidable crises the industry is also capable of instigating. I hope that with a better understanding of how we arrived at this crisis, we’ll be able to chart a path out of it.

I hope you have a good weekend.  Weekend Clips are below.