National Drug Commissioner says decline in overdoses is positive, but much remains to be done

Early data from the Center for Disease Control (CDC) shows that overdose deaths in the United States dropped dramatically by 12 percent last year. During the same period, drug overdoses in West Virginia fell by nearly 11 percent, nearly keeping pace with the national average.

To get a glimpse into this encouraging development, Appalachia Health News reporter Emily Rice spoke with West Virginia resident Dr. Rahul Gupta, director of the Office of National Drug Control Policy (ONDPC). Here's the conversation.

The following transcript has been lightly edited for clarity.

Rice: At the end of your opinionThey say the decline in overdose deaths is both a glimmer of hope and an urgent call to action. The activists I've spoken to on the ground here in West Virginia also see this as a call to action, but they're hesitant to celebrate these numbers because they're preliminary and because, in their view, one overdose death is still too many. So how should we interpret this preliminary data from the CDC when we talk about the drug epidemic?

Gupta: I think we should look at this the same way we've always looked at this kind of data. When President Biden and Vice President Harris took office in January of 2021, this similar data showed that drug overdose deaths were up 31 percent year-over-year, 31 percent. And that's why President Biden and Vice President Harris made it one of their top priorities from day one and made historic public health and safety efforts over the last four years to reduce drug overdose deaths across the country. If you look at this data now, we can see the most recent version of the data showing this 10 percent decrease in overdose deaths. This, again, is the opposite of what we saw in this similar data of a 31 percent year-over-year increase. However, these aren't just numbers. These are lives, and we didn't go from a more than 30 percent increase in drug overdoses year-over-year to a decrease by accident. It wasn't by accident. The reason is that President Joe Biden and Vice President Kamala Harris made this a top priority from day one and committed to transforming the way our country deals with this epidemic through a whole-of-society response. So over the past year, the Biden/Harris administration has taken more historic actions and made more unprecedented investments, which I want to talk about, than at any time in the history of this country to address this crisis head-on.

The President's 2022 strategy laid out very clearly that we will see this kind of progress if we have a clear policy strategy and invest in it. That's why the President and Vice President have been looking at how best to address two major drivers: One is untreated addiction. The other is the profits from drug trafficking. On untreated addiction, under the leadership of President Biden and Vice President Harris, we have removed decades-long barriers to substance use disorder treatment. We have invested more than 40 percent more than the previous administration in funding treatment in communities across the country, particularly in West Virginia. And we have expanded access to life-saving overdose medications, overdose medications like naloxone, which is not only available over the counter, but is also more affordable than ever in history. On public safety, we have seized more fentanyl at the port of entry in the last two years than in the last five years combined. We've also installed more drug detectors at the border to stop the flow of fentanyl and convicted hundreds of victims of drug trafficking, from the illicit Chinese chemical companies to drug cartels to their lawyers and supporters. And finally, we're also working to increase international efforts to disrupt the entire global illicit drug trade. So this progress that we're seeing is important to reach this milestone. But also remember that there's so much work to do, but at this point and in history, we seem to understand what policies work and why we need to invest in them. And that's exactly why the President and Vice President aren't going to stop. They're standing with the American people and they're going to keep fighting, both in Congress and with anyone who doesn't believe in the unity agenda, because Biden would say this is not a red state or blue state problem. This is an American problem, and we need to make sure we tackle it together as a country.

Rice: What do you think is the most effective measure to reduce overdose deaths that the Biden-Harris administration has implemented since January 2021? I know it takes time, more data and research to determine which initiatives against substance use disorders have been most effective. Do you think some of this is due to the easy availability of FDA-approved over-the-counter Narcan and Naloxone, etc.?

Gupta: Well, I think there were certainly a number of aspects, both on the public health and public safety side, including approving the overdose reversal drugs for over-the-counter purchase, as you mentioned, and making sure they're affordable. So it's a historic investment to get these life-saving drugs into the population, no matter where you are. So, for example, the State Opioid Response (SOR) and Tribal Opioid Response (TOR) programs have shipped nearly 10 million kits, 10 million kits of these overdose reversal drugs to the population. We've brought together the U.S. drug manufacturers that have FDA approval for overdose reversal drugs in a number of ways and explained to them how they can access these drugs and afford them to save more lives. We've also not only expanded access to treatment, but we now have 15 times more providers nationwide than we did under the previous administration. We have also ensured that telemedicine for methadone is available in the long term and that the barriers to methadone are reduced.

When you look at the prevention, early intervention, harm reduction approach that was not only policy-enshrined but funded at the federal level for the first time in United States history, you look at the expansion of treatment in historic ways, and then finally recovery. We've worked to build a nation that's ready for recovery through businesses that are ready for recovery. All of that, combined with the historic seizures of fentanyl at the border and the destruction of the border, are separate but combined and integrated actions that have worked, as one strategy mentioned earlier, addressing those two root causes of untreated addiction as well as drug trafficking.

Rice: Thinking about your home state, which has been hit hardest (if not the hardest) by the opioid epidemic, what steps can West Virginians concerned with substance use disorder prevention and treatment take to ensure overdose rates continue to decline?

Gupta: Well, thank you for asking that. I was just back home a couple of months ago and we met with the One Box initiative…that's a return to the holistic approach. I mean, they reminded me that when I was commissioner, we had committed $120,000 to that program and that we're now seeing the graduates of that program, the work of the program and that specialists are available for peer recovery support. That's that kind of work. And then we got 13 new commitments to the White House Challenge to Save Lives from Overdoses from colleges and universities working across West Virginia. Then we also had meetings with local officials and representatives of the students and other agencies, and representatives from the police, schools, community, health care and partnerships. You know, it's heartwarming for me to see that we're making progress in my home state, but at the same time, it's really important to understand and learn from those that we've lost and leave no stone unturned to make sure that we save the next life that we can save. That's why it's important to deploy all the tools available to save as many lives as possible through these evidence- and data-driven actions. There's now clear evidence that Vice President Harris and President Biden's agenda is having a positive impact on the state, but there's still so much work ahead of us.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.