“Exciting.” “Unprecedented.” “Hopeful.” “Great.” These are some of the words that have been used to describe the CDC’s announcement last month that drug overdose deaths are in decline across the United States. In the midst of an opioid epidemic that has killed hundreds of thousands of Americans, the news was welcomed. But while many have been quick to celebrate, I believe it is too soon to celebrate.
To start, we do not yet know the cause of the decline. Some think the supply of fentanyl entering our country might be “drying up” due to global crackdowns on drug cartels and fentanyl smugglers. Others suggest today’s drugs are cleaner, or the increased availability of drug testing kits has made it easier for users to root out fentanyl-laced drugs before accidental use. Could the driver of the decline be clean injection sites? Or the rising availability of naloxone, a medication used to reverse an overdose? Or the growing number of public awareness campaigns about the opioid epidemic?
Many experts say the decline in overdose deaths is a mystery, and they are right. But until we solve it, we cannot celebrate. Many of the reports on the CDC’s announcement, for instance, pointed to naloxone as a possible cause of the decline. While it may be a possible cause, it is only one possible cause. While naloxone can save a life, if its administration is not followed by treatment, it may just delay a death. And even still, we need to get to the root of the problem. From housing to job placement, increasing access to social services can improve or even save a life.
This brings me to my second point. Death is only one data point — and not always the most important one. Deaths and emergency room visits are easy to capture, and therefore easier to count. But if we dig deeper, drug use data is spotty at best. Many of those addicted to opioids are unlikely to participate in surveys, and even if they did, the stigmatization of drug use would likely lead to underreporting. So we don’t know how many people are addicted, or how many people have recovered or relapsed. We don’t know the impact of addiction on children, families or communities, or if the situation is getting better or worse.
Again, until we know, we cannot celebrate. After all, an overdose death is a terrible thing, but living with addiction can be terrible, too. As long as there are people in this nation who are struggling with addiction, there is work to do.
That is perhaps what worries me the most about celebrating the CDC’s announcement — that Americans will think the long national nightmare that is the opioid epidemic is over. In the 1980s, as HIV infections and HIV-related death rates skyrocketed, so did Americans’ use of condoms. Then, as the prevalence of prevention medications like PrEP increased and HIV-related death rates declined, there was a drop in condom usage. And now, we are seeing a rise in sexually transmitted infections, particularly among young people. In public health, we know that if Americans think the risks of death are lower, their behaviors can get riskier. Not incidentally, we also know that if American policymakers think death rates have declined, so will their support for the services that help save lives.
Millions of American families have struggled and suffered due to the opioid epidemic. Indeed, it is a painful chapter many would prefer to relegate to the rearview. And so, it is understandable why the CDC’s announcement received such fanfare. At the same time, we must all be cautious and critical as we analyze this announcement. The topline data tells us something but not everything — and until we know more, we simply cannot celebrate.
