How a startup hopes to treat the rural opioid epidemic, at a profit

Portugal has gone perhaps the farthest in decriminalizing drug use. It hasn't stopped drug usage, but it has reduced deaths, the spread of H.I.V., drug crime, and imprisonment.

Drug-assisted recovery has proved to be very effective for people seeking sobriety from opiate addiction. Drugs such as Suboxone, Methadone, and Vivitrol help addicts by eliminating the ability to get high on opiates and curbing their craving. These drugs combined with psycho and behavioral therapy can help people achieve long-term recovery.

Kansas City is trying to prevent people who have mental health or substance abuse disorders, from committing crimes. In order to do that, the city created a police crisis intervention team. They help people access treatment through the Kansas City Assessment and Triage Center, or other treatment centers. “Everything we do here is to really bridge them into whatever that long-term need is.” It’s too early to tell if the method is working, but police officers, judges, and addicts, argue it is. “It's amazing. It puts a smile on my face every day, and I have got a future coming.”

In Colorado, four communities are piloting a program that offers low-level drug or prostitution offenders an alternative to prison. This program, known as Law Enforcement Assisted Diversion, matches the offender with a case manager who in turn connects them with treatment and training resources.

The United States has continuously put resources towards fighting the war on drugs, but a recent research collaborative that resulted in a comprehensive model has shown that there is a lot to be learned from the failures of these efforts. Although still in the early stages, the model is being turned into a virtual lab that will serve to test newer strategies to determine realistically adoptable solutions.

Across New Hampshire, youth are leading the fight against substance abuse. Programs like Dover’s Youth-to-Youth, Stand Up Sachems, Youth Leadership Through Adventure, and the Making it Happen Coalition, are all youth-led, adult-supported initiatives that are empowering young adults to create and disseminate substance abuse awareness and prevention campaigns. Fundamental to each of these efforts effective communication and creating a sense of community as key to prevention.

Vermont's hub and spoke model of care has gained notoriety as being a system that has successfully played a positive role in creating better access to health care, especially as it relates to the opioid crisis. Now, officials in New Hampshire are looking to scale and adapt the program to work in their state.

The CDC's 2016 guidelines on prescribing opioids for chronic pain attempted to address the opioid-addiction crisis by restricting the supply of the drugs at their source. The guidelines discouraged their use when possible and suggested strategies to taper patients off of them. Since then, thousands of people have lost access to necessary medications and to their doctors, thanks to overreactions to the CDC guidelines that unintentionally led to deaths by street drugs or withdrawal.

Fifty years on, America's war on drugs has failed at its principal goals: to eradicate illicit drug use and sales, to repair communities damaged by the drug trade, and to prevent drug-related deaths. Despite massive amounts spent on law enforcement, which has created great social harms and fueled incarceration, drug use has rebounded to 40-year highs, drug overdose deaths are peaking, and supply of illegal drugs is abundant. Policy advocates say a combination of legalization and public-health approaches to the problems would accomplish more than the wasteful, ineffective "war" mentality used to date.

San Francisco considers the scaling of safe injection sites, which were successfully piloted in Vancouver, to become the first city in the United States to offer this service. However, the main challenge of starting such a service in San Francisco is helping the public get over the concern that safe injection sites encourage drug use for non-abusers. Community groups actively educated the public on the benefits of safe injection sites and politicians made trips to Vancouver to observe the success in action.