The U.S. drug disaster is as dangerous because it’s ever been, and there are few indicators issues are getting higher.
About 110,000 individuals died of drug overdoses in 2023, about the identical as in earlier years. Fentanyl, the highly effective artificial opioid that now dominates the illicit drug market, remained the primary wrongdoer. Xylazine, the veterinary sedative often known as “tranq,” solely grew to become extra widespread. And increasingly more Individuals are utilizing different medicine — particularly methamphetamine and cocaine — alongside opioids.
Nonetheless, dependancy medication and drug coverage hasn’t modified a lot previously yr. Regardless of robust rhetoric from President Biden and lawmakers on Capitol Hill about tackling the opioid epidemic, Washington didn’t move any main reforms to the dependancy remedy system. Not a lot modified on the native degree, both, although cash is lastly flowing to communities from the a number of opioid settlements that have been just lately finalized between drug producers, drug distributors, and pharmacies within the wake of overprescribing scandals within the early 2000s.
Nonetheless, change is occurring — even when not all of it may be characterised as progress. Beneath, STAT breaks down the three dependancy medication tales to look at in 2024.
Will methadone entry increase?
Arguably the most important debate in dependancy medication is over methadone, a extremely efficient drug used to deal with opioid dependancy. Regardless of the remedy’s spectacular numbers in relation to stopping overdose and demise, it’s extremely restricted — presently, sufferers searching for methadone remedy can get it solely at a specialised clinic that sometimes requires them to indicate up in individual every day for a single dose.
Methadone is tightly regulated partly as a result of it’s an opioid itself, and might trigger overdose when misused or utilized in mixture with different substances or drugs.
However more and more, affected person advocates, dependancy medical doctors, and even lawmakers and high-profile Biden administration officers have argued that intense methadone rules are doing extra hurt than good.
A lot of the present debate facilities on the Modernizing Opioid Remedy Entry Act, or MOTAA, a invoice that will enable board-certified dependancy medical doctors to prescribe methadone on to sufferers. A Senate committee authorized the laws in mid-December, although it’s not more likely to develop into regulation.
Nonetheless, the invoice and shifting opinion on methadone has clearly involved methadone clinics, which collectively launched a public relations blitz titled “Program, Not a Tablet” meant to emphasise the opposite providers they supply, like psychosocial counseling.
What to look at is whether or not the Biden administration will act of its personal accord to make methadone extra accessible. It’s additionally doable that extra methadone clinics might benefit from new Covid-era rules and develop into extra liberal with giving sufferers take-home doses.
Will there be a return to police-first drug coverage?
Because the drug overdose disaster has worsened, the U.S. has typically warmed to hurt discount, the philosophy of serving to individuals who use medicine keep secure whereas acknowledging they might be unable to cease utilizing altogether. Hurt discount providers like needle alternate, fentanyl or xylazine check strips, and even supervised consumption — creating sanctioned areas for drug use in order that professionals might intervene within the occasion of an overdose — may help scale back charges of overdose, illness transmission, and demise.
It’s doable, although, that Individuals are dropping their persistence. Sen. Tom Cotton (R-Ark.) final yr brought about a firestorm when he accused the Division of Well being and Human Companies of offering federal funding to incorporate sterile pipes — “crack pipes,” as he referred to them — inside “secure smoking” kits, though the Biden administration clarified it by no means deliberate to provide away pipes and didn’t help federal funding for smoking implements. Lately, state legislatures and native governments have moved to ban syringe alternate. The Biden administration hasn’t backed down from a lawsuit, initiated by the Trump administration, meant to forestall a Philadelphia nonprofit from working a supervised consumption website. Democratic officers in California and Pennsylvania have additionally moved to oppose supervised consumption.
On the similar time, the U.S. has seen a resurgence of advocacy for hardline, police-first ways even in left-leaning cities which have traditionally argued their drug coverage will favor compassion over punishment. In California, Gov. Gavin Newsom and San Francisco Mayor London Breed have stepped up drug-related arrests. In Oregon, polls present voters might quickly reverse a 2022 measure that largely ended felony penalties for low-level drug possession offenses. In the meantime, former president and 2024 hopeful Donald Trump has advocated for executing drug sellers.
It’s exhausting to inform which course drug coverage will flip subsequent yr, and a few communities are nonetheless working to increase harm-reduction choices. Nevertheless it’s clear no less than some types of hurt discount are dealing with important resistance — and most of the communities hardest-hit by the overdose disaster are amongst these pivoting quickest to the police-based method.
Will telehealth be given a task in restoration?
One of many largest modifications that Covid-19 dropped at drug coverage was a right away, main enlargement of entry to dependancy medication by way of telehealth. Specifically, the federal authorities in early 2020 made it far simpler to entry buprenorphine, one other widespread remedy used to deal with opioid dependancy. Dependancy medical doctors celebrated the emergency measures as a win for entry, and knowledge collected because the modifications largely reveals that they helped individuals enter and stay in remedy with out main unintended penalties.
Because the pandemic wound down, nonetheless, the Drug Enforcement Administration moved to roll again a few of these emergency measures. To many dependancy medical doctors, the transfer represents a drastic rollback of entry — all for the sake of stopping buprenorphine misuse, which they are saying is neither widespread nor harmful.
After dealing with immense blowback from medical doctors, affected person teams, telehealth firms, and Democratic lawmakers, the DEA formally delayed its last determination all the way in which till December 2024, that means the Covid-era flexibilities stay in place for now.
However the company and Congress will quickly must determine what the way forward for telehealth dependancy medication appears to be like like long-term. One invoice from a bipartisan group of senators would successfully preempt the DEA’s determination, permitting medical doctors to prescribe by way of telehealth on a everlasting foundation. In fact, it’s doable the DEA will attain the identical determination by itself. Both approach, till a choice is reached, quite a few firms whose enterprise mannequin depends on telehealth buprenorphine — and extra importantly, 1000’s of medical doctors who’ve prescribed and sufferers who’ve taken the remedy with out an in-person go to — stay in limbo.
STAT’s protection of persistent well being points is supported by a grant from Bloomberg Philanthropies. Our monetary supporters aren’t concerned in any selections about our journalism.