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Secrets and stigma lead to record number of opioid overdose deaths

Society does not appear to understand the magnitude of the issue, despite the fact that we call it a crisis.

Sarah Kelly, right, is embraced by Sue Howland after Howland presented her with a coin marking Kelly's one-year anniversary in recovery, outside her home in Guyandotte, W.Va., on March 17.David Goldman/Associated Press

Understandably, COVID-19 has dominated conversations about health for the past year and a half. But the opioid epidemic hasn’t gone away. People — some of them our patients and many who never make it to a treatment program like ours — continue to die from opioid addiction.

The Centers for Disease Control and Prevention recently reported that drug overdose deaths reached an all-time high in 2020, with 93,000 Americans losing their lives. More than 60 percent of those deaths were from synthetic opioids like fentanyl, the powerful drug found all across the country. Another recent study suggests that these opioid deaths are vastly underreported. As we observe National Recovery Month, it is critical for society to recognize the crisis, understand how secrets and stigma allow it to grow, and marshal resources to continue to battle opioid addiction.


“We’re only as sick as our secrets” is an Alcoholics Anonymous proverb that refers to the roles that honesty and shame play in addiction. Those battling addiction — and their families — must talk about their experiences in order to expose the truth of their fights. The shame and secrecy around addiction has contributed to society’s lack of understanding. Society does not appear to understand the magnitude of the issue, despite the fact that we call it a crisis. While outstanding efforts have been made in the areas of prevention, diagnosis, and treatment, these efforts simply have not matched the breadth of the problem.

Those who suffer from opioid addiction must often overcome three layers of stigma in order to accept evidence-based treatment. The first is the stigma of mental illness. Most people are more likely to accept a diagnosis of a physical disease, such as high blood pressure, stroke, or COVID infection, than a diagnosis of addiction, which is often seen as a character flaw or weakness rather than the chronic medical condition it is.


Next, addiction brings a second layer of stigma on top of this — greater than other mental illnesses such as depression or anxiety. This layer of stigma is reflected in the exhausted silence about the opioid epidemic: families are more likely to talk about a daughter’s depression than her addiction.

Finally, the use of medications to treat opioid addiction faces resistance that forms a third layer of stigma. While medications like buprenorphine, methadone, and naltrexone have been proven to save lives, many people seeking treatment for opioid addiction don’t want these medications, believing that the only recovery that counts is one that does not include any drug at all.

Of course, the question that matters most of all is what we do next. Educational efforts are needed to make certain everyone knows what opioid addiction looks like, how to tell if a loved one may be developing a problem with opioids, and the elements of an evidence-based response to reduce the consequences of opioid use. These efforts must reach everyone: Data suggest that opioid overdose deaths among Black people are increasing faster than for other racial and ethnic groups. We have interventions, including mutual help groups like Narcotics Anonymous, and medications, for both treatment and overdose prevention, that work, and it is crucial that people understand these interventions and have access to them. We must also ensure access to treatment for especially vulnerable groups, including those without housing and those involved in the legal system.


We can start the process of saving lives with a simple step: talking about opioid addiction. We have kept too many secrets for far too long. Only honesty about our struggles will create the momentum necessary to mount a response that can halt the growing crisis. We have to share our stories of both losses of loved ones and treatment successes. Talking about those who have lost their battles with addiction may push others to get the help they need. Celebrating treatment successes gives people hope that this is a battle that can be won.

These are secrets we cannot afford to keep.

Dr. Ian Halim is a psychiatry resident and Dr. Kevin P. Hill is director of the Division of Addiction Psychiatry, Beth Israel Deaconess Medical Center.