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Tales from the Trenches

Tales from the Trenches

Widespread abuse of opioids is a scourge in American life — and the latest battlefield of a failed “war on drugs.” An estimated 1.2 million people in the United States age 12 and over currently have an opioid use disorder, according to a recent survey by the Substance Abuse and Mental Health Services Administration.

In his new book, physician Joshua M. Sharfstein, vice dean for public health practice at the Johns Hopkins Bloomberg School of Public Health, brings vital experiences in policy, politics and best practices — and even optimism — to his survey of the crisis and the damage it has wreaked on individuals and communities.

“A lot of people have felt fatalistic, as if nothing can be done,” says Sharfstein. “[But] I’ve seen success on opioids in Baltimore. My experience of government is that if you actually implement policies based on evidence, then you get results.”

For instance, Sharfstein observes that a “sustained decline” in heroin overdose deaths in Baltimore between 1999 and 2011 “coincided with a real focus on expanding access to treatment and a real engagement of the medical community in offering treatment.”

Sharfstein forged his career in public health policy and government at the local, state and federal levels. He was the health policy assistant to congressional public health crusader Rep. Henry A. Waxman before becoming Baltimore City’s health commissioner, a position he held from 2005 to 2009. Next was a stint as principal deputy commissioner of the Food and Drug Administration, and then the post of secretary of the Maryland Department of Health and Mental Hygiene in 2011.

“One thing I’ve noticed from having worked in government,” he says, “is that people bring a whole set of assumptions to addiction that they don’t bring to other issues.”

The opioid crisis has elicited more compassionate rhetoric from politicians for those with substance abuse disorders, but Sharfstein says that police still remain polarized over how to prioritize treatment over criminalization.

“I see a big divide,” he says. “I see law enforcement leaders who want to try new things aside from arresting people … but you also see more traditional thinking, such as turning overdose sites into crime scenes.”

The Opioid Epidemic, co-authored with Yngvild Olsen, medical director of the Institutes for Behavior Resources Inc., uses a Q&A format to offer clear information on many aspects of the crisis for those in government, as well as for those personally affected by it. There is a primer on the mechanism of opioid addiction, details on how it affects families and nuanced policy recommendations to forge solutions. The authors also share (and dispel) many common myths related to opioid addiction.

Sharfstein, who holds a joint appointment in the school of medicine, says that researching the history of opioid abuse was the most illuminating part of his work on the book. America’s previous challenge with opioids in the late 19th century led to a sweeping ban in 1914. It was a legal regimen that was not relaxed until the 1980s — when increased prescription usage set the stage for today’s public health emergency.

“You look at the problem we’re facing today, and you think: ‘It’s never been like this before,’” says Sharfstein. “But you look at the history, and you realize there have been a lot of parallels to what we are experiencing. This is not even the first opioid crisis that the country has had, and you can see the echoes of the previous crises in our thinking on opioids.”

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