International Overdose Awareness Day: Fighting Stigma and Bringing Change
International Overdose Awareness Day occurs every Aug. 31 and is the largest global campaign to bring awareness to rising overdose rates. Combating this issue requires complex considerations, including removing stigma around substance use disorder, providing harm reduction, and educating the public on this growing issue.
Overdose-related fatalities in the U.S. alone are increasing at an alarmingly rapid rate. From 2012 to 2023, overdose deaths climbed from 41,502 to 107,543, an astounding 159% increase in just over a decade. Another notable trend shows that while statistics on teen drug use are decreasing, overdose rates among teens continue to rise. One cause for this is the prevalence of opioid drugs, both prescription and illicit.
“The vast majority of teen drug overdose deaths involve illicit fentanyl,” said Gary M Reisfield, MD, an addiction medicine psychiatrist with UF Health who also serves as a forensic expert with UF Health Forensic Psychiatry. “Often, fentanyl is incorporated into counterfeit prescription medications, such as oxycodone and Xanax, and users may not even be aware they are using fentanyl.”
Fentanyl’s danger lies in its potency. The U.S. Drug Enforcement Administration estimates that compared with common prescription opioids like morphine, fentanyl is 100 times more potent. Even the potency of street drugs pales in comparison to fentanyl’s, which is estimated to be 50 times stronger than heroin. Adding to the danger is the growing trend of illicit drugs being laced with fentanyl to encourage returning customers.
“People come into detox and we’ll find cannabis and fentanyl in their drug screen,” said Laurie A. Solomon, MD, an addiction psychiatrist with UF Health who practices at the Florida Recovery Center, or FRC, and provides psychiatric consultation for a local non-profit organization Anew. “They’ll say they’ve never used fentanyl and believe they are telling the truth, not realizing that the marijuana has been laced with fentanyl to get them to keep coming back for more.”
When it comes to treating substance use disorders, stigma remains a significant barrier to addressing this public health issue and subsequent overdose rates.
“The public doesn’t understand that this is an illness. It’s a medical condition,” Dr. Solomon said. “It needs to be looked at and treated as a medical condition.”
Studies reveal those suffering substance use disorders are likely to be seen as dangerous, unpredictable, and unable to make decisions about treatment or finances. They’re also likely to be blamed for their condition.
“There has long been tension between the perception of substance use disorders as brain disorders versus moral failings,” Dr. Reisfield said. “Substance use disorders are brain disorders, affecting brain circuits involved with emotions, insight, decision-making, cognitive control, and reward and motivation — circuits designed to help us meet foundational needs around nutrition, procreation, and social bonding.”
Stigma around substance use disorders not only prevents those suffering from seeking treatment, but it hinders enacting meaningful public policy that could provide greater access to treatment.
“When patients don't have the ability to access treatment because they don't have insurance or the financial ability, the illness prevails and progresses,” Dr. Solomon said.
In response to substance use disorders and overdose rates, campaigns like International Overdose Awareness Day began in order to educate the public and remove the negative stereotypes around this issue.
“Passing bills that support opening treatment programs and creating better access to programs will help,” Dr. Solomon said. “And providing education, even through schools.”
Relatively new initiatives seeking to join the fight include greater access to Narcan, the first naloxone product approved for use without a prescription. Narcan reverses the effects of overdose, blocking the impact of opioids on the brain and restoring breathing. In doing so, it can save lives when it is easily attainable.
Supervised injection or consumption sites are showing up across the nation as well. Substance users can visit these spaces and consume or inject with medical oversight and no legal ramifications. The goal of these sites is to improve health outcomes through harm reduction and education.
“Harm reduction programs recognize that substance use disorders and their attendant devastation are not going away any time soon and seek to reduce the harm associated with drug use,” Dr. Reisfield said. “Available evidence suggests that they decrease ER visits and hospitalizations, overdose deaths, and the transmission of HIV and hepatitis C.”
Another goal of these sites is to provide outreach for those suffering substance use disorders, offering a safe space to learn about options to help them overcome their disorder.
“It really is harm reduction,” Dr. Solomon said. “If they’re sick and tired of being sick and tired, and they want to find sobriety and recovery, this can be lifesaving. At the least, it gives the individual an opportunity to allow their brain to heal as they make a major lifestyle change and learn to embrace recovery, knowing that they are not alone.”
Although critics worry that implementation of these sites will bring more drug usage and crime, they have been shown to reduce public concerns by providing a space where patients can partake — one that is not open to the public, such as restrooms, streets, and parks.
Public awareness around substance use disorders and overdose fatalities is increasing. However, to address this complex issue as the fatality rate increases, experts are calling for changes to educational and public policies.
People can get involved in overdose prevention in a number of ways. Many communities, including Gainesville, offer resources and treatment programs.
“Get acquainted with local resources,” Dr. Reisfield said. “UF HealthStreet offers a variety of resources, including Narcan training and distribution, substance use disorder research studies, and volunteer opportunities in their CAMEO program.”
One developing program at the University of Florida is the Bystander Overdose Action Team, or BOAT, coordinated through UF HealthStreet., The program offers workshops, support, and education on being prepared should you encounter an opioid overdose.
“The potential to become a bystander unites us all, regardless of social demographic” states Joel Rowe, MD, an emergency medicine services physician and co-medical director of the UF BOAT.
“We realize that most people are not prepared to respond if faced with an opioid overdose, nor do they have Narcan,” said Sarah Vas, MD, an addiction child psychiatrist and co-medical director of the UF BOAT. “Our team came together naturally with representatives from all levels of UF. We’re interested in increasing awareness so that we can reduce stigma and fears associated with addictive behaviors.”
Enacting change on a state and federal level is another necessity that will help to meet the rising need for meaningful policy changes.
“Contact your representatives — at the local, state, and federal levels — to express concerns, support constructive drug policies, and emphasize the need for improved funding for prevention and treatment programs,” Dr. Reisfield said.
Education remains at the center of fighting high overdose rates, with the goal of removing the stigma around substance use disorders and replacing it with compassion and a desire to help those in need.
“Without the education, the epidemic is going to grow more exponentially,” Dr. Solomon said. “The more we can educate and destigmatize, the more aware people will be about this medical condition, and the safer our society is going to be.”
If you or a loved one are struggling with substance use disorder help is available. The UF Health Florida Recovery Center offers a renowned program using evidence-based, results-oriented treatment that focuses on the physical and emotional aspects of recovery. As part of an academic medical center, FRC offers comprehensive care and treatment for other medical conditions that may co-occur with substance use disorder. Recovery is possible — contact FRC today to learn more.
Resources:
Florida Recovery Center (855-265-4372)
UF Health Psychiatric Hospital
Learn more about Bystander Overdose Action Team (BOAT): Narcan training, overdose awareness resources, and volunteer opportunities.
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