Resolution on Supporting Those Affected by the Opioid Crisis

Submitted by the Commission on Social Action

Background: 

The Misheberach L’cholim, the Prayer for the Sick, asks for the healing of the body as well as the soul. Jewish tradition has long maintained that we are obliged to partner with God to help in the act of healing. Deuteronomy commands that every individual “shall indeed guard [their] soul[s]” (4:15). Leviticus reminds us that this commitment extends beyond the role of the individual, with the directive to “not stand idly by while your neighbor’s blood is shed” (19:16). Our tradition also teaches the danger of stigmatizing members of the community, as we learn in Pirkei Avot: “Do not disparage anyone, and do not shun any thing. For you have no person who does not have their hour, and you have no thing that does not have its place” (4:3).

The Reform Movement has also long understood the need to address substance use disorder (SUD; until recently termed “substance abuse”) and mental health within our congregations and the broader communities of which we are a part. URJ Resolutions including “Drugs” (1971), “Substance Abuse” (1989), “Dealing with Substance Abuse” (1993), and “Establishing a Comprehensive System of Care for Persons with Mental Illness” (2001) and CCAR resolutionsincluding “Drug Trade and Drug Legislation” (1993), “Establishing a Comprehensive System of Care for Persons with Mental Illness” (2001), and “Syringe Exchange Programs” (2001) have spoken to the need for improved care and treatment and reflect the ongoing evolution in the ways these issues are viewed and addressed in law and in our communities. Decades of URJ and CCAR resolutions have also addressed related issues of health care access, racial justice, and care for children.

These lessons and history are foremost in our minds and hearts as we face a continent-wide opioid epidemic. Preliminary data suggests that over 68,000 Americans died from drug overdose in 2018^[1] with a majority involving opioids.^[2] In comparison, in 1995 at the height of the HIV/AIDS epidemic, 43,000 people died from the virus.^[3] Canada’s nearly 4,000 opioid-related deaths in 2017 reflects an equally daunting challenge.^[4] 

Opioids are drugs used to treat pain. They are naturally found in the opium poppy plant and also made by scientists in labs.^[5] This includes prescription drugs like hydrocodone and oxycodone as well as illegal drugs like heroin. Opioid medications are a crucial part of pain relief for many patients with serious illnesses and continue to play a vital role in pain management. However, they also pose serious risks for abuse. In the 1990s and 2000s, the opioid prescribing rate increased dramatically, eventually peaking in the United States and Canada between 2010-2012, and declining modestly since.^{[6, 7]} Unfortunately, many prescription drug users have transitioned to using heroin and other illicit drugs, which increasingly are laced with highly potent synthetic opioids like fentanyl. This helps explain the enormous increase in opioid-related drug overdoses and deaths over the last several years.

The causes of the opioid crisis are diverse, including pharmaceutical companies’ aggressive sales tactics, over-prescription of opioids by doctors, the ease of purchasing illicit drugs, stigma associated with seeking help, ongoing economic dislocation, and a broken criminal justice system that prioritizes punishment over treatment.^{[8, 9]}

The effects of the epidemic also go far beyond the individual level. Children of opioid users often experience long-term health effects and trauma related to their parents’ substance abuse disorder, particularly children suffering from neo-natal abstinence syndrome^[10] and the overwhelming number of children who enter the foster care system due to the opioid crisis.^[11] Family and friends of opioid users face continual emotional upheaval as well as financial challenges from helping their loved ones. Educational, public health, and law enforcement resources are diverted from other important issues in areas where the opioid crisis is most severe. Patients may also be denied needed, responsible opioid prescriptions by physicians concerned about changing societal views.

As with mental illness, the ongoing stigma surrounding opioid addiction also informs the way that local, state, provincial, and federal governments have responded to the opioid crisis and previous drug-related crises. For decades, the U.S. government addressed drug use and overdose primarily as an issue of criminal justice, rather than public health. The “war on drugs” focused resources and attention on suppliers of illicit drugs, demonized drug users, and unjustly targeted communities of color. These factors contributed to the high levels of drug-related incarceration in the U.S. and made it harder for those with SUD to find treatment, health care, jobs, and stable housing. Canada’s incarceration rate, far lower than the United States’, is 18th among the 36 OECD countries.^[12] Canada’s approach to drug use diverges substantially from the U.S., including the recent national legalization of marijuana^[13] and permitting the use of safe injection sites and heroin-assisted treatment to minimize the likelihood of overdose.^[14] Many harm reduction advocates have praised these measures but contend that further reform is necessary.^[15]

In the U.S., federal programs such as Medicare, Medicaid, CHIP, and the Affordable Care Act play a role in addressing the opioid crisis and supporting those with SUD.^{[21, 22, 23]} For these reasons, experts have advocated for the expansion of Medicaid^[24] and opposed the imposition of work requirements on Medicaid participants.^[25]