By Patricia A. Roos
On May 11, 2015, our 25-year-old son Alex died of a heroin overdose in a vacant lot in Newark.
It was every parent‘s worst nightmare, the worst case among many moments in Alex’s addiction. This year, May 11 was Mother’s Day. To mark the 10th anniversary of Alex’s death, we had brunch with friends and walked in DC‘s Rock Creek Park.
We feel close to Alex there.
Momentous occasions call for agonizing reappraisals. As a nation, we can see the failures of criminal-legal strategies for overdose and addiction. The War on Drugs cannot be won, the demand for opiates is independent of our will and determination to control them. But old ideas die hard and can be quickly revived with new political winds.
The measure of success, or failure, is good data. The CDC‘s National Center for Health Statistics reported that 49,293 Americans died in the 12 months preceding that terrible May 2015. This overdose indicator soon spiraled upward, peaked at 111,466 in June 2023, and then declined to 80,674 by November 2024, still an astonishing body count by any measure. However, the decline in overdose rates was primarily observed among white individuals, while rates remained disproportionately high among Black and Native Americans.
Harm reduction works
There are good signs amid the bad. A public health approach helps a lot. Harm reduction is now more common, and some have linked it to overdose declines. During Alex’s addiction, I never heard the words “harm reduction.” Yet by 2021 it was the stated policy of the Biden administration, which launched the Substance Abuse and Mental Health Services Administration’s Office of Recovery.
In 2015, Alex could only access abstinence-based, 12-step programs. There was utter disdain for anti-opioid medications at the 12 rehabs Alex attended. Rehabs often work on old ideas, turning away from medicines that can help. Medications for opioid use disorder are more common now, but too few rehabs use them. I still wonder if a compassionate world steeped in harm reduction might have given us more time with Alex.
Nationally, life-saving strategies such as buprenorphine and naloxone are more common. Libraries, schools, pharmacies, restaurants, and other establishments often stock naloxone. Restrictions on methadone maintenance were reduced during Covid-19, allowing more people to bring their medicine home. Through the bipartisan Mainstreaming Addiction Treatment Act of 2021, the federal government eliminated the X-waiver, which required DEA approval to prescribe buprenorphine.
Reduce law enforcement‘s role
These strategic advances reduced law enforcement‘s role in addressing addiction. Underscoring a shift to public health, the American Medical Association voted in 2024 to support eliminating criminal penalties for possession of illegal drugs. Alex was arrested for marijuana possession in 2014, diminishing his prospects for recovery. By 2021, New Jersey legalized marijuana.
Multiple states have moved to decriminalize cannabis. Other states use a “hub and spokes” model, as a compassionate alternative to punitive strategies. New York City established two overdose prevention sites for people in active addiction. Rhode Island and Minnesota followed suit.
Safe injection sites save lives and do not foster addiction.
Addiction could happen to anyone
The stigma of addiction hurts those addicted, as well as families. We now know that addiction can happen to anyone. Family members have become activists in honor of children lost to addiction. When Alex died, I wrote an obituary and eulogy about Alex’s substance use. Such openness was rare then but no longer is.
Armies of strong women and men now stand up to stigma, and that helps. Communities of activists have emerged. Now countless communities of grief provide support and hope for desperate parents.
Trump administration is getting it wrong
Although we enjoyed successes in the last decade, harm reduction and other addiction strategies are again under attack. We can expect the overdose rate to tick upward. The Trump administration’s policies blame the fentanyl problem on immigration, misdirecting our attention from things that work. They are all in for law enforcement.
The administration mentions a few demand strategies. In his recent address at the Rx and Illicit Drug Summit in Nashville, RFK Jr. underscored the “nuts and bolts practical things” like suboxone and fentanyl test strips needed to counter addiction. But their actions do not match their rhetoric.
Cuts in research
We can‘t reduce addiction and overdose by destroying agencies driven by those goals. The Republican administration has cut $11 billion in grants to state and counties’ health departments and nonprofit groups, eviscerating meaningful solutions.
The administration’s policy statement contains no mention of harm reduction, or SAMHSA. And multiple SAMHSA offices have been closed.. Additional cuts happen daily.
The Trump administration eliminated the only existing nationwide survey on substance use and mental health. Advancing ignorance about a problem guarantees that solutions remain elusive. Destroying skill and expertise opens doors to ineffective approaches.
Antiquated approach
Supporters of the president‘s drug policies, especially the Heritage Foundation, speak of harm reduction with scorn, misrepresenting the strategy’s goals. Harm reduction’s objective has always been to “meet them were they are, but not leave them there.” The blueprint for the Trump administration — Project 2025 — doesn’t mention harm reduction at all.
RFK Jr. blames victims for their addiction. What worked for him 40 years ago — belief in God and peer therapy from daily 12-step meetings — is his panacea for those now suffering from addiction.
Like his boss, Kennedy believes that “addicts” should be out of sight” and off our cities’ streets. His “out of sight” places are drug rehabilitation farms where they will be “re-parented” with apparently no addiction treatment medicines and no medical providers. He makes no mention of the dangers of previous “therapeutic communities,” accused of abusive behavior toward clients.
While RFK’s strategy might have worked for him, we need multiple paths to recovery.
We could learn from our neighbor to the north. Canada has made meaningful progress in addressing addiction. Harm reduction is a core pillar of Canadian addiction policy, which recognizes substance use and mental health as concurrent disorders. And, of course, unlike in the U.S., these strategies supplement a publicly funded healthcare system.
We must not go back
Since we lost Alex, the country has moved away from the unproductive idea that addiction lies exclusively with the individual. “Just say no” never worked.
And yet it appears that we may be headed back there. I can agree with Kennedy that addiction is a “source and symptom of misery,” but his insistence that only fixing individuals will reduce that misery will fail. Resisting that approach is critical, as is a broader focus that lets us see the importance of social, political, and economic environments as “sources of misery.”
We must not go back to punishing approaches. We should attend to larger, systemic issues that allow us to fully embrace public health strategies. It is possible to save more of our children.
Calling your elected representative in the U.S. House Of Representatives or U.S. Senate is the most effective way to influence policy. To find your representative and senator to voice your position, go to the House website and the Senate website.
Patricia A. Roos wrote Surviving Alex: A Mother’s Story of Love, Loss, and Addiction, published May 17, 2024 by Rutgers University Press.
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