Los Angeles County is amid the worst drug overdose crisis in local history — and things are likely to get worse before they get better unless we take bold action.
Tragically, over seven Angelenos die of drug overdoses every day, a trend that is largely being driven by fentanyl and methamphetamine. Between 2016 and 2021, fentanyl deaths and poisonings have soared by 1280% and methamphetamine-related deaths have increased by 379%.
Overdose deaths have impacted communities regardless of race, ethnicity, socioeconomic status, or age. While White residents have experienced the highest numbers of fatal overdoses, Black and Latino residents have been disproportionately impacted after adjusting for differences in population size. Non-fatal and fatal overdoses have also been on the rise in every age category, including among youth.
Although the opioid epidemic has made headlines for years, the widespread emergence of fentanyl has made the epidemic more sinister. Extraordinarily small amounts of fentanyl can cause people to stop breathing, resulting in brain damage or fatal overdoses within a matter of minutes.
Because of its potency and the difficulty detecting it without testing, fentanyl is being mixed by dealers in both illicit drugs and counterfeit pills that look like commonly prescribed medications. The result? An alarming number of people are unknowingly exposed to fentanyl and poisoned. Similarly, the potency of methamphetamine is also increasing, often resulting in overdose leading to strokes, heart attacks, or serious psychiatric consequences.
It’s clear that we need a paradigm shift in our thinking about addiction treatment by assuring that substance use services are designed not just for people who are ready to stop their use of drugs, but also for people who continue using but are ready to take steps to avert overdose. The concept that there is a spectrum of risk associated with substance use and that there must be a continuum of services offering prevention assistance at every step along that continuum is known as “harm reduction.”
Harm reduction includes a range of strategies that prioritize the health and well-being of people who use drugs over complete abstinence from substances. It is grounded in respectful and nonjudgmental services that meet people who use drugs wherever they are along the continuum of recovery.
In fact, harm reduction is an aspect of medical care for many diseases and conditions already. For example, we do not tell people with diabetes that they can’t be eligible for treatment unless they comply with diet restrictions 100% of the time or that people with heart disease can’t receive care unless they exercise. Medical systems recommend these interventions but also accept that people may be at different points of their readiness to engage in these activities, no matter how beneficial they may be.
Harm reduction is about keeping people who use drugs alive and as healthy as possible. By opening lines of communication with individuals regardless of their readiness for treatment, harm reduction strategies build relationships and promote trust between people who use drugs and service providers, creating an environment that may lead to openness to substance use treatment or the cessation of substances for those who are open to this end goal.
While harm reduction as a concept is not new, integrating it as a central component of the substance use system is. It represents a tremendous opportunity to extend the reach of services to all those in need and not just the small proportion of people who are ready and interested in full abstinence from substances.
Harm reduction services include the distribution of the overdose prevention medication called naloxone to people who use drugs and to anyone they may encounter, and test strips to help users check whether the drug they are using is laced with deadly fentanyl.
An additional critical step for Los Angeles County would be the establishment of overdose prevention centers that offer unconditional entry, sterile supplies, and medically supervised environments for people to use their pre-obtained drugs. Safer consumption strategies have been demonstrated to significantly reduce the likelihood of overdose deaths and other health risks associated with illicit drug use. These sites do not furnish drugs to people; they furnish a safer environment for people to use the drugs they are going to use anyway.
Evidence from international overdose prevention centers has demonstrated that these services reduce morbidity and mortality related to drug overdoses, reduce the use of emergency medical services, enhance access to substance use treatment, reduce the public use of injectable drugs, and reduce the spread of communicable diseases such as HIV and hepatitis, all without significant disruption to public safety.
In addition to these benefits, overdose prevention centers and other actions demonstrating a harm reduction philosophy send a subtle but important message that we want to bring people who use drugs out from the corners of our communities and that they deserve unconditional and nonjudgmental services that will reduce their risk, promote their well-being, and connect them with necessary health and social services.
Controversy surrounds safer consumption sites because zero-tolerance drug policies are often viewed as the only acceptable option for people with substance use disorders. However, the fact is that we’ve already put our eggs in the zero-tolerance basket for decades and it’s led us to the unenviable position we’re in today.
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The ability to expand harm reduction strategies should be coupled with an increased focus on addressing the root causes of human suffering with upstream interventions. At its root, substance use is often associated with a lack of connection to meaningful relationships, activities, and purpose. By investing in emotional well-being and positive youth development programs that provide opportunities for connectedness and meaningful relationships with others, we can address some of the root causes of risky behaviors, including substance use, and minimize their downstream ramifications.
The overdose crisis is complex and multi-faceted, and undeniably connected with many of society’s toughest challenges, such as homelessness, inequity, violence prevention, and justice reform. This is why approaching this issue from different angles through a cross-sector, community-wide, and fresh perspective is so important. Lives depend on us getting this right.
Barbara Ferrer is director of the Los Angeles County Department of Public Health. Gary Tsai is division director for substance abuse prevention and control at the Los Angeles County Department of Public Health.