The United States is in the grip of an opioid epidemic that has been aggravated by expanded use of the drug fentanyl—an extremely potent, unregulated drug often added to heroin, ecstasy, and fake OxyContin. Richard Frank and co-author Harold Pollack wrote a Perspective article in the New England Journal of Medicine offering solutions that hinge on targeting the system of fentanyl delivery and reducing the consequences of the harm as a result of the drug.
Known as harm reduction, such tactics “[seek] to place the burden of reducing unintentional fentanyl consumption on the individuals and organizations that can most effectively reduce that risk,” according to the article.
By contrast, use reduction aims to reduce the consumption of illicit drugs, which, according to the authors, will not have as large of an impact. The effects of use reduction are limited to local drug dealers and provide fewer incentives. Furthermore, users are not aware of the drug entering their system—so identifying the drug channels and penalizing use of fentanyl in other drugs would have a greater impact in its presence farther downstream.
Channeling the market in less harmful directions, by contrast, requires transparency for policy planners and users through improved surveillance, better understanding and access to treatment for users, incentives for suppliers not to use it and targeted treatment for those at greatest risk for overdose.
The approach would also, based on successes from the Affordable Care Act, rely on better access to treatment and medical therapy so that users can get the care they need.
According to the authors, “Although the ACA’s future is uncertain, we are heartened by strong bipartisan support for its provisions on coverage for mental and substance use disorders and for other initiatives to expand access to treatment (in the 21st Century Cures Act).”
Frank has recently written and spoken about the opioid crisis in an effort to alert policymakers about the need for research about the drug. On February 10th, 2017, he was quoted in a New York Times article about the effects of Obamacare on substance abuse treatment.
“The whole system is being pushed more toward looking like modern health care,” he said, but if people lose their insurance, they will lose the associated benefits.
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