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How To Solve The Opioid Epidemic

GrowSF Clubhouse series

How To Solve The Opioid Epidemic

Meet the head of Obama’s task force, Sarmed Rashid, for a discussion on the opioid crisis, the root causes, and how the government is addressing it.

When: Wednesday, March 17, 5PM PT

Guests:

  • Tom Wolf - Housing & Addiction Advocate
  • Sarmed Rashid - Strategy & Special Projects, White House ONDCP
  • Dr. Philip Coffin - Director of Substance Abuse, San Francisco DPH

Hosts:

Notes

Causes of Rise in Opioid Cases in SF

  • Primary case is the rise of fentanyl vs heroin
  • From 2005 to 2016, there were 9000 to 25,000 users of opioids but negligible increase in overdoses
  • But fentanyl since 2018 resulted in spike we see today
  • Fentanyl is 10-100X stronger and cheaper than heroin; death from overdose happens in minutes, vs 30+ min for other drugs
  • Secondary cause is drug markets - SF has largest open air and organized drug dealing market in Bay Area
  • Law enforcement releases any drug dealer arrested, with lax impunity, leading to perception of lax policies
  • The issue is one of supply and demand - given spike in individuals addicted, and lax criminal policies, more drug dealers come to SF

Federal / National Causes and Trends

  • ONDCP is the sister agency of the National Security Council
  • ONDCP funds: a) substance abuse prevention programs with grant money, b) coordinates federal, state, local (DEA, PD, State Police) to share information on drug networks, c) control the drug budgets of federal agencies that have local departments (I.e. HHS, Labor)
  • Noted there has been an exponential increase in overdoses since fentanyl as well - given price and potency
  • Also noted addiction is often correlated with unemployment and lack of community support
  • Disproportionate effect on white population, which has less social capital and community support
  • This is exacerbated in pandemic, because access to 12-step meetings, counseling, is reduced

Potential Solutions

  • Need to look at solutions from a funnel perspective: get addicted, then acknowledge addiction, then seek help, then get a doctor, then pay for doctor, then find the right treatment
  • Any failure at any point in that funnel will hinder progress; biggest gap tends to be in acknowledging addiction, and finding access to good treatment
  • Coercive interventions to ensure they get into a detox bed
  • Keeping drug dealers locked up for 30-90 days (not necessarily 15 years) - even short-term sentences will help disrupt criminal operations, and reduce supply
  • Drug Court - get police and social workers to provide treatment and recovery programs and if they complete them, no sentence
  • Criminal Justice Reform - make it easier for people with felonies to get a job - given systemic oppression, people resort to selling drugs because they cant get another job
  • Naloxone (Narcan) program to reduce mortality rates - reversal agent for opioids
  • Treatment Centers for same day triage and syringe access programs

Limitations on Solutions

  • One primary issue is finding treatment - when Tom was homeless he didn’t know where to find a detox bed
  • There are only 50 detox beds in SF, but 5000 addicted
  • No funding of 12-step abstinence programs
  • Illicit manufacturing of drugs is what caused increase in crime given illegal access
  • A lot of precursors to fentanyl are made in China and shipped to US or Mexico; need to solve it at its source
  • China did finally declare fentanyl a controlled substance, so may start cracking down
  • Tracking of mail packages for fentanyl in FEDEX and UPS is not effective

Potential 10X solutions

  • Address systemic inequality in wealth
  • Have on-demand treatment systems, dont require ID for treatment
  • Stop the illegal precursor shipments from China/Mexico for fentanyl
  • Handle injectable opioids for those without access to treatment

How Audience Can Help

  • Learn CPR
  • Learn how to deliver NARCAN
  • Address stigma of addiction - watch the word choice you use “suffering from addiction vs an addict”