The addiction crisis of today is not the same as those that preceded it even 2 years ago, and while there are reasons for concern, CDC director Rochelle Walensky, MD, MPH, told Rx Drug Abuse & Heroin Summit attendees in a session presented Wednesday morning that she also sees reasons for hope.
“We aren’t operating in the dark,” she said. “We are applying the public health tools available to us to understand the epidemic, how it is changing, who is at risk, and where we need to focus our interventions.
“The crisis continues to evolve, and our public health response must be nimble—flexible to changing realities on the ground.”
Among those changing realities has been a transition from a wave of overdose deaths fueled by opioids to those linked to heroin and synthetic opioids in recent years. Today’s substance use crisis is dominated by illicit synthetic opioids, a resurgence of methamphetamine and cocaine, and polysubstance use, Walensky said. She noted a recent CDC study that showed 85% of drug overdose deaths in 24 states involved illicitly made fentanyl, heroin, cocaine and/or methamphetamine.
The evolving illicit drug market has made synthetic opioids, methamphetamine and cocaine more widely available. The mixing of synthetic opioids into illicit supplies of counterfeit prescription medications, methamphetamine and cocaine has put individuals who normally wouldn’t use opioids at high risk for overdose when unknowingly exposed, Walensky said.
Public health officials, however, know more now about risk and protective factors, and it is time “to translate this knowledge into action and into our communities,” she said. One area of focus for CDC is the prevention of adverse childhood experiences (ACEs). Two decades of research show a strong link between ACES and increased risk for substance use, Walensky said. To that end, CDC has released a prevention resources that includes evidence-based strategies for ACE prevention that communities can adopt as part of their substance use prevention efforts.
CDC is also working with state, local, tribal and territorial partners to enhance linkages to care and capitalize on new public health strategies to ensure people are connected treatment and recovery services, especially at high-risk times, such as after a non-fatal overdose, when being treated in ED, and when re-entering the community after incarceration, Walensky said.
On the harm reduction front, the agency is working with public health departments and other partners to scale up syringe service programs, expand use of naloxone, and enhancing other strategies.
“Taking this comprehensive approach is essential because it allows us to address the immediate challenge of rising overdose deaths while simultaneously working hard to prevent future substance use addiction and overdose,” Walensky said.