What the COVID pandemic can teach us about the drug pandemic

I have spent much of my professional career analyzing drug trafficking trends and their impacts. One question that continues to confound me is why more people aren’t talking about it. 

Americans are enamored by the drug trade in pop culture. There is no shortage of movies, books, music and television shows focused on illicit drugs. Sadly, this seems to be where most Americans’ interest ends. When it comes to the real world, where more than 100,000 Americans died from drug overdoses in the past year, relatively few Americans are aware of the scale of the problem and the devastation it has wrought.        

The sad truth is that drug use has become “endemic,” at least in the public conscience. Indeed, many Americans now believe drug use is part of the human experience and have called for an end to the so-called “war on drugs.” In this view, drug use is a personal choice and an assumption of risk, much like those that choose not to get vaccinated against COVID-19.      

This has led to a renewed interest in “harm reduction” — a set of ideas and interventions aimed at reducing the negative impacts associated with drug use. Unlike approaches that seek to prevent drug use, harm reduction policies recognize many people are unwilling or unable to abstain and should instead seek to keep drug users “safe,” including the distribution of drug testing strips, the overdose-reversing drug Naloxone and clean needles for intravenous drug use.   

Although not often described as harm reduction, the U.S. has embraced similar measures as part of its response to the COVID-19 pandemic; for example, wearing facemasks, social distancing and more liberal use of hand sanitizer. It is yet to be seen whether these practices will continue after the immediate crises (mercifully) recede. However, it is likely many of these precautions will persist and become additional tools in the public health toolbox.    

And like COVID, there are limited treatment options for those caught in the grip of drug addiction. According to the long-awaited report by the U.S. Commission on Combatting Synthetic Opioid Trafficking, most people with opioid use disorder “receive no treatment, and only a small share of those in treatment receive medication treatment, which is the option with the strongest evidence base, while some treatment programs are based on no evidence at all.” This sounds an awful lot like the early days of the COVID pandemic, where ventilators and some antivirals proved to be moderately effective treatments, while others, such as hydroxychloroquine, ivermectin and even disinfectants like bleach were shown to do more harm than good.  

What lessons does the COVID pandemic have for the drug crisis? In the first instance, there is no vaccine for drug use. While some medications such as methadone, buprenorphine and naltrexone may reduce opioid cravings and withdrawal while blunting or blocking their effects, and harm reduction measures may decrease the risk, the only surefire way to avoid addiction and overdoses are to abstain. Likewise, treatment options remain limited, and those that are fortunate enough to access them have mixed results.    

In recent years, drug prevention and supply reduction strategies have fallen out of favor, with a growing emphasis on harm reduction and treatment. However, if we’ve learned anything from the COVID-19 pandemic, it is that the worst outcomes can be prevented by “stopping the spread.” The dangers of drug use today are too great, too deadly, for us to rely on harm reduction or treatment alone. We must stop drug abuse before it starts through evidence-based prevention efforts, and we must reduce the availability of drugs through more aggressive, upstream interventions.   

We may have missed our chance to eradicate COVID-19 and illicit drugs, but that does not mean we should settle for the worst-case scenario. We can — and should — overcome both, but it will require time, money and perhaps most importantly greater awareness and unity of effort.  These diseases don’t discriminate, and we must use all the levers we have — prevention, supply reduction, harm reduction, and treatment — to see us through these dark times.    

Jim Crotty is the former deputy chief of staff at the U.S. Drug Enforcement Administration. He is currently an associate vice president at The Cohen Group, a strategic advisory firm based in Washington, DC. The views and opinions reflected in this piece are solely those of the author.