"A Public Health Approach to Overdose Prevention": Director's Remarks at Project Lazarus, Wilkes County, North Carolina

STATEMENT OF
R. GIL KERLIKOWSKE
DIRECTOR
OFFICE OF NATIONAL DRUG CONTROL POLICY
EXECUTIVE OFFICE OF THE PRESIDENT

at

PROJECT LAZARUS

WILKES COUNTY, NORTH CAROLINA

“A PUBLIC HEALTH APPROACH TO OVERDOSE PREVENTION”
 AUGUST 22, 2012

As prepared for delivery --

Thank you to Project Lazarus and especially to Fred Brason for having me here today.

Project Lazarus is an exceptional organization—not only because it saves lives in Wilkes County, but also because it sets a pioneering example in community-based public health for the rest of the country.

I’m glad to have the chance to highlight the important work done at Project Lazarus, and to discuss the Obama Administration’s approach to overdose prevention.

When the Office of National Drug Control Policy released this Administration’s first National Drug Control Strategy in 2010, we established a new blueprint for reducing illicit drug use and its consequences in America.

This blueprint was based on decades of research from the Nation’s top neuroscientists who demonstrated that drug addiction is a disease—one that can be prevented, treated, and successfully recovered from.

This blueprint was built with the knowledge that drug use endangers the safety and health of millions of Americans, and that our country was in need of a new direction in drug policy—one based in common sense, sound science, and solutions that are proven to work.

So, we allocated unprecedented funding for treatment programs, we invested in educating at-risk young people about the dangers of substance abuse, and we reinvigorated drug courts. We strengthened law enforcement to rid our streets of drug dealers who infect our communities.

As a former police chief, I’ve seen the devastating effect that substance abuse can have on people, families, and communities. But I also know that we cannot arrest our way out of the drug problem. Law enforcement will always play an important role in bringing criminals to justice, but we cannot—and do not—respond to substance dependence with incarceration.

That’s why my office’s most recent Strategy allocates $10.1 billion for drug prevention and treatment programs—more than we allocate for U.S. law enforcement and incarceration. This Administration understands that substance dependence is a health issue—not necessarily a criminal justice issue—and we support innovative ways to bring treatment to people who need it most.

Project Lazarus is a striking example of this kind of innovation. The rate of prescription drug abuse in this country is now at the level of an epidemic, and Wilkes County, North Carolina, has borne a disproportionately large amount of the suffering caused by this epidemic.

In 2009, the rate of death in Wilkes County due to unintentional poisoning was nearly four times the North Carolina state average, and these deaths were due almost exclusively to prescription opioid pain relievers.

The problem is not just local—it’s national. Today, drug induced deaths are the leading cause of injury death in the United States, surpassing motor vehicle fatalities, suicides, gunshot deaths, and homicides.

Prescription painkiller overdoses were involved in nearly 16,000 deaths in 2009. That’s about four times the 4,000 people killed by these drugs at the end of the 90s. Our most recent data show that nearly 3,000 Americans died in 2009 from unintentional overdose related to intravenous drug use—a 58% increase over the prior decade.

While my office is committed to reducing illicit drug use in America, we are equally committed to reducing the harmful consequences of drug use, too. With the rate of drug-induced deaths in America at such an alarmingly high level—not to mention drugs’ impact on health, relationships, and productivity— we’ve got our work cut out for us. To put this in economic terms, it’s estimated that illicit drug use costs this country $193 billion annually in public health costs and lost productivity in the workplace.

Drug prevention—especially overdose prevention—is a critical piece of our mission. To supplement our National Strategy, last year we published plan to respond to America’s prescription drug abuse crisis.

The four-tiered approach—which focuses on education, tracking and monitoring, proper medication disposal, and enforcement—calls for a 15 percent reduction in the number of unintentional overdose deaths related to opioids by 2015.  

We can achieve this goal, but only by collaborating with each other. My office rejects the false choice between public health and public safety often perpetuated by the national discussion about drug policy. Law enforcement and public health officials can—and should—work together using all available tools to reduce the harmful consequences of drug use. 

Here in North Carolina and in other states we’ve seen the life-saving power of this collaboration. In March, Dr. Jana Burson, an opioid addiction specialist in Cornelius, witnessed the power of this collaboration first-hand.

On her blog, she tells the story of a young woman whose life was saved by a naloxone kit distributed by Project Lazarus. The woman, who is only 26 years old, overdosed after taking what was—for her—a “normal” dose of opioids. Her brother, who was an established patient of Project Lazarus, found her unresponsive, not breathing, and her face was blue.

When he called the clinic, his counselor instructed him to immediately call 911, then use the naloxone kit he had been given to save her life. Four days after her near-death experience, the young woman entered treatment. Without naloxone, she wouldn’t have had the choice. While this woman’s story demonstrates the life-saving power of naloxone, I must emphasize that the use of naloxone to prevent an overdose death should be a measure of last resort—not a recurring practice in habitual drug users. Naloxone is a tool of overdose intervention, and once used, can become a critical link to substance abuse treatment—a tool for long-term overdose prevention.  

Naloxone isn’t just the purview of public health professionals—it has become an important tool of law enforcement officers. In 2009, the town of Quincy, Massachusetts entered into a unique partnership between local mental health and addiction organizations and the police department. Working together, these groups persuaded the Massachusetts Public Health Department to fund a program to train officers to resuscitate overdose victims with a nasal naloxone spray.

A year and a half after the launch of the program, officers—often the first responders on the scene of an overdose—are empowered in Quincy to intervene and prevent overdose deaths.  

As valuable as naloxone is, it’s only a small piece of the broad spectrum of drug use prevention. We are serious about removing legal impediments that can mean the difference between life and death. The odds of surviving an overdose, much like the odds of surviving a heart attack, depend on how quickly the victim receives treatment.

When it comes to preventing an overdose death, Naloxone is an extremely valuable tool. But we know that one of the most effective, sustainable ways to prevent overdose is to prevent drug use itself.  

Led by that belief, we have worked with partners in and out of government to develop a formidable toolbox for parents, teachers, young people, leaders and citizens across the country to prevent drug use in their communities.

The “Above the Influence” media program, which provides young people information about the dangers of drug use and inspiration to choose healthier alternatives, has built a community of more than a million people on Facebook and has touched millions more through local and national outreach events.

The Drug-Free Communities program, which distributes grants to more than 700 communities throughout the United States, reflects our understanding that effective drug prevention—just like effective public health support—must occur at the local level.

And once a substance use disorder develops, it’s critical that we make drug treatment available. In this country, we do not forsake people who need treatment for addiction. It’s not just our policy to expand access to treatment services—it’s the right thing to do. That’s why President Obama made coverage for substance abuse treatment mandatory in the Affordable Care Act.

We have made huge progress on the legislative and policy fronts during the past three years. We’re focusing our resources on health-based and prevention programs with proven success records. But we realize that in order to truly turn the tide on substance abuse and overdose rates, we must work together to break the stigma of addiction. We must continue to share stories of successful treatment and sustained recovery to offer hope to people who are struggling with addiction.

Only by bringing the promise of recovery into the light of day can we rob addiction of its power to keep its victims in darkness.  By attacking the root cause of overdose, we can prevent more needless deaths in the future.

My office remains steadfast in its support of a health and science-based approach to this Nation’s drug problem. We’re pleased to partner with groups on the forefront of drug policy like Project Lazarus to build a safer, healthier America.