Opioid deaths have declined, but there is still work to be done

“Exciting.” “Unparalleled.” “Hopeful.” “Great.” These are some of the words used to describe the CDC‘s announcement last month that drug overdose deaths are declining in the United States. Amid an opioid epidemic that has killed hundreds of thousands of Americans, the news was welcomed. But while many were quick to celebrate, I believe it is still too early to celebrate.

To begin with, we do not yet know the cause of the decline. Some think that the supply of fentanyl entering our country may be “dry up” as a result of the global crackdown on drug cartels and fentanyl smugglers. Others suggest that current drugs are cleaner, or that their availability is increasing drug testing kits has made it easier for users to eradicate fentanyl drugs before they are accidentally used. Could the cause of the deterioration be clean injection sites? Or the increasing availability of naloxone, a drug used to reverse an overdose? Or the growing number of public awareness campaigns about the opioid epidemic?

Many experts say the drop in overdose deaths is a… mysteryand they are right. But until we fix it, we can’t celebrate. For example, many of the reports on the CDC’s announcement pointed to naloxone as a possible cause of the decline. Although it could be a possible cause, it is only one possible cause. Although naloxone can save a life, if its administration is not followed by treatment it can only delay death. And yet we must get to the heart of the problem. From housing to job placement, improving access to social services can improve or even save a life.

This brings me to my second point. Death is just one data point – and not always the most important. Deaths and emergency room visits are easy to record and therefore easier to count. But when we dig deeper, the data on drug use is spotty at best. It is unlikely that many of those addicted to opioids will participate in studies, and even if they did, the stigmatization of drug use would likely lead to underreporting. So we don’t know how many people are addicted, or how many people have recovered or relapsed. We don’t know the impact of addiction on children, families or communities, or whether the situation is getting better or worse.

Again, until we know, we can’t celebrate. After all, an overdose death is a terrible thing, but living with an addiction can be terrible, too. As long as there are people in this country struggling with addiction, there is work to be done.

That’s perhaps what worries me most about celebrating the CDC’s announcement — that Americans will think the long national nightmare of the opioid epidemic is over. In the 1980s, as HIV infections and HIV-related death rates skyrocketed, so did Americans’ use of condoms. When the prevalence of prevention medications such as PrEP increased and were HIV related mortality rates denied, there was one decline in condom use. And now we see A increase in sexually transmitted infectionsespecially among young people. In public health, we know that when Americans believe the risks of death are lower, their behavior can become riskier. Not coincidentally, we also know that if US policymakers think death rates have fallen, so will their support for the services that help save lives.

Millions of American families have struggled and suffered from the opioid epidemic. It is indeed a painful chapter that many would rather relegate to the rear. And so it’s understandable why the CDC’s announcement received so much fanfare. At the same time, we must all be careful and critical when analyzing this announcement. The topline data tells us something, but not everything – and until we know more, we simply can’t celebrate.