Giving Compass’ Take:
• A report on Brookings summarizes the most recent research on effective drug addiction prevention efforts in the United States.
• Why is drug addiction prevention such a complex issue? What can we do to support those suffering from the effects of drug and alcohol addiction in our communities?
Drug policy often comprises efforts to reduce the supply of drugs, to provide health and social services to addicted individuals, and to prevent the development of addiction in the first place. The last of these efforts—prevention—is the subject of this paper. The scientific literature on drug policy offers some insights on the relative effectiveness and cost-effectiveness of different strategies for preventing traditional opioid misuse and related harm. But these insights don’t apply perfectly to the current opioid crisis in the U.S. and Canada, due to many important differences between today’s epidemic and those of the past (e.g., heroin in the 1960s and 1970s). School-based universal primary prevention programs, for example, will probably remain only modestly effective, mainly because it is mostly adults, rather than adolescents, who initiate opioid use through prescription drugs. However, there are new opportunities for prevention, including promoting safer opioid prescribing, and issuing public health warnings about fentanyl’s dangers and the need to keep prescription opioids locked up.
Looking across the preventive strategies reviewed in this paper, four meta-lessons emerge:
- Regions not yet exposed to black market fentanyl should use every tool available, including traditional drug law enforcement, to delay its arrival; but such enforcement should be recognized as a holding action, not a long-term solution.
- Elements of the legal opioid industry whose corporate tactics violate laws and regulations—at home or abroad—should be treated like illicit drug cartels, including potential criminal prosecution of their leadership.
- Well-meaning clinicians, patients, and pharmacies need nudges and system redesign, not just education, to avoid becoming unwitting accomplices in the opioid crisis.
- A small subset of clinicians, patients, and pharmacies are criminals; they should be investigated aggressively, and their activities stopped.
Because prescription opioids remain the dominant route through which opioid use disorder is initiated, reducing its incidence can translate over time into reduced deaths not only from prescription opioids, but also from heroin and fentanyl. Enforcement against licensed producers and distributers may perform well even if enforcement against traditional dealers does not.