Too Many Lives Lost: Learning From Global Leaders in Harm Reduction and Treatment

Author: Evan Gumas Jesse Baumgartner Munira Gunja

Theme: Social Science & Policy Research Year: 2022

Drug overdose deaths have increased in many high-income countries during the COVID-19 pandemic,
with much higher mortality rates in the U.S., Scotland, and Canada. Lessons can be learned from peer
nations on how to increase access to treatment for drug use disorders and reduce the number of
preventable deaths.
Using the most recent data available from the CDC, EMCDDA, and contacts and databases at
international health and drug monitoring agencies, we created cross-national comparisons on drug
overdose mortality rates and the percentage of higher-risk opioid use populations receiving medicationassisted treatment.
Countries included were Australia, Canada, Denmark, France, Germany, Netherlands, Norway, Portugal,
Sweden, Switzerland, U.K. (England, Scotland, Wales), and the U.S.
• The U.S. reported the highest unadjusted rate of overdose/drug-related deaths in 2020, 277 per
million residents, followed by Scotland and Canada. Other countries were below 100 deaths per
million residents.
• France (87%) and Norway (86%) report the highest rate of opioid-substitution treatment
coverage, while the U.S. had the lowest rate at just 11%.
• Regarding policy, Portugal decriminalized the use of illicit drugs and uses local commissions to
assess treatment need. In contrast, the U.S. criminalizes drug use and incarcerates people at a
much higher rate, disproportionately impacting people of color.
• Countries like France and England have streamlined access to medication-assisted treatment,
while the U.S. has strict regulatory guidelines making it difficult to receive a prescription.
Countries with the highest rate of overdose deaths have much to learn from peer countries. Recent local
initiatives in the U.S. such as drug decriminalization and safe consumption sites have led to reductions in
overdose deaths, reflecting some of the progress made in peer countries.
Disclosure of Interest Statement:
The authors note that there were no conflicts of interest in the creation of this publication.

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