Why are we rejecting life-saving overdose prevention?

May 16, 2023

By Courtney Wise

Plus, what some jurisdictions are doing to protect jurors’ mental health – and whether ‘mental health awareness’ for conditions like anxiety and depression has become so socially on trend that severe illnesses like schizophrenia are pushed to the shadows.

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Supervised injection sites keep people from dying. Why are legislators voting them down?

Drug overdoses have killed more than a million Americans since 1999, more than all those killed in battle during all wars the U.S. has fought in its history, according to a report in Medical Economics earlier this year.  Fatal drug overdoses have also been climbing over the last few years, reaching more than 100,000 annually at last count. But much like our gun death epidemic, which is unparalleled in the world, legislators are not taking even the most simple steps to stop it.

One of the most basic steps is harm reduction, including supervised injection sites. But despite research showing that they are effective at reducing overdose deaths – as well as as emergency room visits to treat overdoses and crimes associated with drug use – lawmakers in state legislatures across the United States remain largely unwilling to authorize overdose prevention centers in their communities.

“We need to prioritize sobriety, not just allow addiction to continue and spiral,” Pennsylvania state Sen. Christine Tartaglione, a Philadelphia Democrat, told the Washington Post. Tartaglione introduced a bill that bans such centers from opening in Pennsylvania; it passed on May 1 with large bipartisan support. A similar bill was recently passed in Democratic-controlled Colorado. 

Opponents of safe use sites say the centers will attract more drug use, crime, and blight into communities. But advocates argue such worries haven’t become reality at safe use sites in Canada, Australia, France, Portugal, or the only government-authorized safe use center in the United States, OnPoint NYC.  Since opening two years ago, OnPoint NYC has helped more than 3,200 people by connecting them to addiction and mental health treatment, job training, other social services, and preventing 898 overdose deaths. “This isn’t complicated. It works everywhere it’s opened. It should be open here,”  said Ronda Goldfein, vice president of Safehouse, a nonprofit that’s spent years pushing to open an overdose prevention center in Philadelphia. 

The reason U.S. refuses to take these basic steps? Moralistic blinders, according to our review of Maia Szalavitz’s Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, which suggests we strain the moral judgments out of our approach to addiction and just concentrate on saving lives. For more on this issue, see Vince Bielski’s earlier story for MindSite News entitled “Overdose Deaths Now Top 100,000 a Year, Why Do So Few People Addicted to Opioids Get Treatment That Could Save Them?

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Stay cool to help protect your mental health

Record-breaking temps are rolling over the globe, including Asia last week, and scorchers in Africa and Western Europe in April. Researchers say the heat is just a sign of what’s to come this summer – and in the coming years – as a result of climate change. Epidemiologists are on alert as a result, looking closely at connections between rising temperatures and their effect on the mentally ill. They found that people with schizophrenia were three times as likely to die during the heatwave that blazed Canada and the Pacific Northwest in summer 2021.

“We knew that schizophrenia was a risk factor,” environmental health scientist Sarah B. Henderson told Time magazine, “But the magnitude of the risk we observed in this particular event was very surprising – head and shoulders above those other risk factors, and not in a good way.”

Some people with severe mental illness, including schizophrenia, may be unable to perceive how dangerous heat conditions are. “If you are in a 50°C (122°F) room, and you are not perceiving the risk, you are going to die,” Henderson said. 

People who take medication to manage mental illness are at greater risk as well. Lithium, which treats bipolar disorder, can become toxic to users who are dehydrated. Other medications, like tricyclic antidepressants can cause too much sweating, also leading to dehydration, and clozapine, which treats schizophrenia, reduces or stops sweating – the body’s biggest weapon against overheating. “This population is the most impaired, but then they’re taking the most high-risk medication that can further worsen their condition and their ability to thermoregulate,” said psychiatrist Carol Lim.

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In other news…

Jury duty is a key feature of our criminal justice system, but juror’s mental wellbeing hasn’t been closely considered until recently. In the second half of this episode of the podcast Criminal, host Phoebe Judge speaks with judges and jury commissioners working to change the system so that people who serve on disturbing cases can access tangible emotional and mental support during and after jury service. 

Adding digital training to ketamine extends benefit for treatment-resistant depression: A single infusion of ketamine followed by four days of 30- to 40-minute “automated self-association training” − computer exercises using positive words and images to improve self-worth − prolonged the effects on depression for three months, according to study findings published in JAMA Network Open. In a one-year outcomes study, however, there was no statistical difference between the intervention group and two others in the small trial after 90 days.  − Don Sapatkin

Has mental health awareness gone too far? Definitely not. But, writer Martha Gill suggests in this guest column for The Guardian that maybe our awareness of conditions like anxiety and depression have risen so greatly that we’ve let consideration for illnesses like schizophrenia and bipolar disorder fall to the wayside. “Severe mental health disorders are therefore more in need of destigmatisation campaigns but get fewer of them. The theme of last year’s mental health awareness week was loneliness,” Gill writes. “These awareness campaigns seem to work by stretching the concept of mental illness into the realm of common experience – linking anxious feelings to anxiety, or relating depression to the stresses of everyday life…But there’s a problem here. It might be that campaigners have not ‘normalized’ mental illness so much as broadened the definition to the point that it includes the mentally well.”

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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