The devastation of the substance use disorder epidemic in the United States is one of the most urgent public health crises of our time. Last year, more than 107,000 people died from drug overdoses in the United States, the highest number ever recorded.
In Massachusetts, there are more clinical and residential substance use disorder services than ever before. Despite the addition of these needed services, safer drug use and recovery remains elusive for many in active addiction. It is not enough to expand clinical substance use disorder services; there also needs to be meaningful economic opportunities for people who use drugs and people in recovery.
I know the power of financial support because it was critical for my own recovery.
When I walked into my first undergraduate class at UMass Boston in 2008, it was my first time back in a classroom since I dropped out of high school. Then 21, I was newly in recovery from a painful stint of addiction and homelessness. All I had was a GED, a generous girlfriend who let me live with her, and limited low-wage work experience. I grew up poor and no one in my family had earned a four-year degree. My recovery felt fragile and tenuous, but I was eager to defy a miserable fate of addiction and poverty.
Countless people in recovery have stories like mine. What made the difference for me is that I was afforded financial support. The Massachusetts Rehabilitation Commission paid for my college tuition and books; my middle school alma mater bought me a laptop; friends lent me money. These were more than just generous gifts; they were faithful testaments of my worth during a time when I felt worthless.
It is common to hear the cliché “addiction doesn’t discriminate,” but Americans experiencing poverty disproportionately suffer negative effects of the drug epidemic. A 2019 study found that economically disadvantaged US zip codes had the highest rates of opioid overdoses. The pioneering economist duo Anne Case and Angus Deaton discovered and named the phenomenon “deaths of despair,” which include drug overdose and alcoholic liver disease. Their research found that those without a bachelor’s degree are far more likely to die a death of despair, and that education is one of the key differentiators of life expectancy for Americans ages 25 to 75. They largely attribute this to the lack of meaningful work opportunities and the inequities of the US health care system.
Policymakers and providers are realizing the critical impact that economic support has on promoting recovery and wellness.
The Massachusetts Access to Recovery program, which offers help with basic needs, comprehensive employment, and life skills, is a thriving program run by the Bureau of Substance Addiction Services. ATR reports that 99 percent of its clients remain substance-free after six months of program completion. On the housing front, the state and the City of Boston have recently increased their investments in low-threshold and long-term housing for people with substance use disorder. These investments are proving successful. Since January, Boston has placed 326 people from the area around Massachusetts Avenue and Melnea Cass Boulevard in low-threshold housing, and 45 in permanent housing.
Results in the private sector are also promising. Contingency management programs, which offer financial incentives in exchange for people engaging in treatment, have an 86- to 88-percent efficacy rate and are changing the way the federal government reimburses care. This change was driven by the Massachusetts-based mobile app company DynamiCare, which is on the forefront of contingency management. DynamiCare cites a two- to four-times increase in quit rate for multiple substances and is currently partnered with local treatment providers and insurers.
Financial incentives are also effective as a harm-reduction strategy. The Boston-based Community Syringe Redemption Program offers cash incentives for syringe “buy backs” to people experiencing homelessness or using drugs. Funded by the RIZE Massachusetts Foundation and City of Boston, this program incentivizes cleanup of discarded syringes, primarily in the Mass. and Cass area. In addition to financial support, participants are offered overdose-prevention resources, referrals to care, and job readiness skills. This innovative program has resulted in a 50 percent decrease in calls for city syringe pickup.
Many still want a tougher approach to people experiencing addiction and poverty. People with substance use disorder are looked upon less favorably than those with mental illness, and economic support programs for people with substance use disorder have low favorability. It has been noted that many local detox beds remain empty; why not force people into treatment? Last year, there was a proposal to force people with substance use disorder from the Mass. and Cass area into the House of Correction.
While involuntary substance use disorder treatment remains legal in Massachusetts, it is less effective for long-term treatment outcomes and increases the likelihood of overdose. Research shows that increasing motivation and opportunity for people with substance use disorder is one of the best courses of action for promoting success.
Continuing punitive policies of the failed so-called war on drugs, which disproportionately punish the poor, will not improve our addiction crisis. If these approaches worked, they would have by now.
I wish I could show the struggling 21-year-old version of myself what his future had in store. Now 36, I have thrived in recovery and am a college graduate with a great career. I’m married with two children and I own my own home. While I can’t travel back in time to assure myself of my worth, I can amplify the successful efforts that give people with substance use disorder the economic opportunities they deserve.
Brendan Little is an advocate, consultant, and serves on the state Opioid Recovery and Remediation Fund Advisory Council.