The overdose crisis
Overall drug overdose deaths reached a record-breaking 107,000 deaths in 2021, according to preliminary data from the Centers for Disease Control and Prevention.1 From 1999 to 2021, more than 650,000 people have died of opioid overdose. In the next decade, it is predicted that 1.2 million individuals will die of opioid-related overdose.2 In recent years, illegally manufactured fentanyl has been implicated most frequently in recent deaths, followed by methamphetamine and cocaine, whereas overdose deaths involving heroin and opioid analgesics have remained relatively stable.1 Beyond overdose risk, substance use is associated with several other health risks. Among people who inject drugs (PWID), sharing injection equipment is the driving factor for hepatitis C virus (HCV) infections and remains a risk factor for human immunodeficiency virus (HIV) infections.
Although HIV infections declined from 2015 to 2019, HCV infection rates have increased for more than a decade.3,4 In addition to HCV and HIV, there have been increases in endocarditis, osteomyelitis, hepatitis B virus, and other infectious diseases among people who use drugs (PWUD).5-8 These preventable health outcomes are the result of multiple decades of inaccessible public health interventions, outdated drug laws that disproportionately criminalize some PWUD, and attitudes among policy makers, the public, and health care providers rooted in racism and stigma. Most people use drugs without criminal penalty and without developing a substance use disorder (SUD). According to data from the 2020 National Survey on Drug Use and Health, approximately 1 in 5 people older than 12 years in the United States used an illicit drug in the past yeardtotaling more than 59 million people. Less than a third of this group, 18.4 million people, met criteria for a SUD relating to their drug use in the past year. Meanwhile, there were 1.5 million drug-related arrests9 in the United States in 2019 and they were disproportionately among black, indigenous, and Latinx people.
10 People who are marginalized, poor, black, indigenous, or people of color are more likely to experience punishment for drug use, develop SUD, and experience health care discrimination including receiving less treatment.11-18 As pharmacists, we play a critical role in providing access to health care for all PWUD and our advocacy must acknowledge how our current policies and structures exacerbate drug-related harms. The following commentary examines the impact of criminalization and incarceration on health outcomes and the concept of decriminalization as a harm reduction strategy for improved patient and community health.
