American Cities on the Front Lines of the Opioid Crisis

More than 72,000 Americans died of drug overdose in 2017, the vast majority related to opioids. It’s a staggering number — so staggering that the national impact of this crisis can sometimes obscure the everyday toll it is taking on individual communities.

Local governments are at the front lines of this emergency, and they confront the consequences of opioid addiction every day: from syringes left on the street and 911 calls, to children placed in the foster care system and neighborhoods unable to attract new investment. Traditionally, the response has been led by law enforcement and emergency responders. But, as the escalating number of overdose deaths attest, progress requires an effective public health strategy, including innovative initiatives and the coordinated efforts of officials at the local, state and federal levels.

Cities are taking the lead — and starting to see results. Many are finding new ways to use data to manage the problem, working to stop over-prescribing of opioids by medical providers, and searching for new ways to expand access to addiction treatment.

New York City, for example, has developed a collaboration between public health and law enforcement officials to improve the response to the opioid crisis by jointly sharing and reviewing data. San Francisco, meanwhile, is providing mobile treatment to homeless individuals who are battling opioid addiction.

Leaders in Burlington, Vt., will soon offer access to treatment in the city’s syringe exchange program. And in Seattle, they’ve developed an innovative policing program that diverts people suspected of nonviolent offenses, including low-level drug crimes, to a broad set of services instead of incarceration.

In these cases and others, mayors are courageously speaking out against societal stigmas associated with addiction. Their message: We need to help people who are addicted to opioids, not simply punish them.

Dozens of other cities tested new approaches through a Bloomberg Philanthropies-funded competition, the Mayors Challenge, which empowers cities to find new solutions to their most pressing concerns.

In Huntington, W.Va., a city of fewer than 50,000 people that has averaged more than five overdoses a day, officials recognized the toll this is taking on first responders. To combat this “compassion fatigue,” support first responders and boost their empathy to overdose victims, city leaders are testing the benefits of offering mental health counseling and self-care programs to the fire and paramedic teams.

In Ithaca, N.Y., they’re exploring the establishment of a supervised consumption facility linked to a broad set of services. The idea, based on evidence from Vancouver, British Columbia, is that individuals who come to such a facility to use drugs safely under medical supervision may stick around for social support, counseling and access to addiction treatment.

And in Cary, N.C., they’re exploring whether it’s possible to measure opioid use on a neighborhood scale by testing the wastewater. If reliable, the data might provide cities a new dimension on the crisis and how to better tackle it.

Of course, cities can’t conquer this crisis on their own. There must be dedicated and coordinated efforts at all levels of leadership in both the private and public sectors. But as these and an increasing number of other cities are proving, it’s time to expand our understanding of what’s possible — to try new ideas, see what works, and then share successful approaches.

Mayors understand that, when faced with such a direct challenge to residents’ health and well-being, standing still is not an option. That’s a lesson we should all take to heart.


Dr. Joshua Sharfstein is the director of the Bloomberg American Health Initiative and associate dean for public health practice and training at the Johns Hopkins Bloomberg School of Public Health, and he previously served as the health commissioner of Baltimore, the health secretary of Maryland, and the principal deputy commissioner of the U.S. Food and Drug Administration.

Dr. Jessica Leighton is part of the public health team at Bloomberg Philanthropies.

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