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27 Million People in U.S. Use Illicit Drugs, Harm Reduction Not Keeping Pace

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Nearly 21 million people in the United States struggle with substance use disorders, according to a new report, Facing Addiction in America: Surgeon General's Report on Alcohol, Drugs, and Health, released this week. Another new report by Harm Reduction International finds that harm reduction services are not adequate in the U.S. or worldwide, though the U.S. has seen some recent improvements.

It is time to change how we view addiction -- to see it "not as a moral failing but as a chronic illness that must be treated with skill, urgency, and compassion," said U.S. Surgeon General Vivek Murthy.

More than 27 million people in the U.S. reported current use of illicit drugs or misuse of prescription drugs in 2015, and over 66 million reported binge drinking in the past month, according to the report. Close to 21 million have a substance use disorder, but only 1 in 10 are receiving any kind of specialty treatment for it.

"Historically, our society has treated addiction and misuse of alcohol and drugs as symptoms of moral weakness or as a willful rejection of societal norms, and these problems have been addressed primarily through the criminal justice system," states the report -- the first-ever surgeon general's report to address substance use disorders.  

"Our health care system has not given the same level of attention to substance use disorders as it has to other health concerns that affect similar numbers of people," the report continues. "Substance use disorder treatment in the United States remains largely segregated from the rest of health care and serves only a fraction of those in need of treatment."

The report describes this is "a time of great opportunity" due to some long-awaited changes in drug policy and a shift toward a public health approach to drug use. Several cities and states have begun to put more emphasis on treatment and management of drug and alcohol misuse rather than punishment.

A dramatic rise in overdose deaths -- largely affecting white rural and suburban communities -- and an outbreak of HIV and hepatitis C in Indiana have brought increased attention to drug addiction, accompanied by calls for increased treatment such as opioid substitution therapy using methadone or buprenorphine, and harm reduction efforts such as needle and syringe exchanges and distribute of naloxone to reverse overdoses.

"Ongoing health care and criminal justice reform efforts, as well as advances in clinical, research, and information technologies, are creating new opportunities for increased access to effective prevention and treatment services," the report continues. "This report reflects our commitment to leverage these opportunities to drive improvements in individual and public health related to substance misuse, use disorder, and related health consequences."

Public health and harm reduction advocates hailed the report. "The Harm Reduction Coalition stands with the Surgeon General in calling for a public health approach to substance use," the organization stated in a press release. "This report will be vital for the harm reduction community in our collective education and advocacy efforts for years to come."

But all bets are off now that the Trump administration is taking over the federal reigns. President-elect Donald Trump has stated on several occasions that he does not favor harsh drug policies and thinks states should have leeway, but his likely cabinet picks include long-time proponents of the war on drugs.

Global State of Harm Reduction

A related report released this month, The Global State of Harm Reduction 2016, looks at availability of key harm reduction services worldwide.

After some advances over the past decade in scaling up needle and syringe programs and opioid substitution therapy for people who inject drugs, this progress has stalled, according to the new report released by Harm Reduction International (HRI).

Out of 158 countries where injection drug use is reported, 68 still do not provide needle exchange programs. In the U.S., these programs are determined on a state-by-state basis. A federal ban on all funding for these programs was lifted in 2015, but federal funds still may not be used to directly purchase syringes.

HRI has tracked a "slow but steady expansion" of harm reduction services through its biennial global report, and 2016 is the first year in which no new countries have started syringe exchange programs -- and in fact access to needle exchange services and opioid substitution therapy has decreased in some countries since the last report in 2014.

HRI has called on governments and the United Nations to redirect attention and funding away from the war on drugs and into harm reduction, pointing to a statistical model that suggests redirecting just 7.5% of the estimated $100 billion spent annually on drug enforcement could come close to ending HIV/AIDS among people who inject drugs by 2030, as well as expanding access to hepatitis C treatment and distribution of naloxone.

"The 2011 UN target to halve HIV among people who inject drugs by 2015 was missed by 80%," said report author Katie Stone. "[T]oday’s report demonstrates that harm reduction is not a fringe position. Harm reduction services are now available in over half of the 158 countries with documented injecting drug use. Where they have been adequately scaled-up, HIV and hepatitis C rates have plummeted."

11/18/16

Sources

U.S. Department of Health and Human Services. Facing Addiction in America: Surgeon General's Report on Alcohol, Drugs, and Health. 2016.

Harm Reduction Coalition. Landmark Surgeon General Report Endorses Harm Reduction. Press release. November 17, 2016.

Harm Reduction International. The Global State of Harm Reduction 2016.