August 31st is Overdose Awareness Day. But after another year grieving lost loved ones, watching addiction devastate communities, and reading tragic headlines daily, we’re all aware of America’s drug crisis.
But there is hope: we’re already armed with everything we need to change our nation’s trajectory.
Proven solutions are available if we break down barriers and demand change — in debunked medical practices, misinformation about drugs and people who use them, and public policies that don’t serve Americans. At a time when it’s challenging to find consensus, we’re unified on this: 83% of Americans say the war on drugs has failed.
We founded Boulder Care, a new type of addiction recovery program, to help create a better way forward.
We’re inspired daily by the strength and resilience of patients building beautiful lives beyond addiction — despite broken political, healthcare, and justice systems working against them.
To people with addiction, those seeking recovery, and people who use drugs: you deserve better.
You deserve better from treatment providers asking for your trust, time, and money and from government agencies that should be protecting you, not punishing you.
You deserve to feel better — healthier, happier, safer, proud of your wins, and empowered to make decisions about your body.
We imagine a future in which America isn't known for the worst addiction crisis and highest incarceration rates in the world — but for having come together as a nation to break the vicious cycle of addiction for generations to come.
Every person deserves every opportunity to recover. We’ll be fighting alongside you to recover your rights.
The Boulder Care Team
What can you do?
With gratitude to these thought leaders for their inspiration and wisdom. We give them credit but views are our own, without endorsement:
Last year, we lost nearly 100,000 Americans to overdose.
Despite billions spent to address the opioid crisis, the death toll continues to climb. Our national focus on arrests, drug seizures, and “cracking down” on opioid prescriptions (legitimate or not) gives the appearance of progress without actually helping anyone.
America’s response has not only been ineffective at saving lives, but is making the drug crisis even worse.
During alcohol prohibition, the US government forced manufacturers to poison industrial alcohol — knowingly sacrificing thousands of lives to stoke fear and set an example.
We’re condemning a generation, rather than taking practical measures to save lives.
Proven tools and tactics like syringe programs, overdose prevention sites, and naloxone (Narcan) reduce hospitalizations, infections, and deaths. But public perceptions — influenced by political motives and misinformation — restrict these strategies, with fatal consequences.
Addressing the opioid crisis must start with valuing and protecting the lives of people who use drugs. We can only help people if they’re alive to receive that help.
Patients with cancer or diabetes usually have access to local providers who accept their insurance and offer evidence-based medical care: a diagnosis, a discussion of treatment options, and a plan to help manage their disease with minimal disruption to their daily life.
Millions confront addiction — another chronic condition — with little to no access to the same standard of care.
Medications for addiction treatment (MAT) — like buprenorphine and methadone — are the most clinically effective treatment for opioid use disorder. MAT is endorsed by the FDA, the WHO, the Surgeon General, the American Medical Association, and every major health agency. Medications cut patients’ mortality rate by more than 50% and improve quality of life and ability to stay in care.
It’s inexcusable that the majority of addiction facilities do not prescribe medications — or worse, ban them. Residential programs often don’t help patients get healthier — or worse, put them in danger; discharged patients have a higher likelihood of overdose.
When MAT is available, it still comes with barriers: from requiring clinic, pharmacy, counseling, and lab visits (as often as daily) to denying care based on pregnancy, legal history, and marijuana or nicotine use.
When France loosened buprenorphine restrictions, overdose rates declined 80% in less than four years. Once we treat addiction as a chronic disease — with already-available medical advances — we can turn the tide of the opioid epidemic.
In 1977, one family spoke out about “solving” their daughter’s addiction by letting her sit in jail until she learned her lesson.
They wrote a bestselling book, and their message was widely adopted by self-help groups and addiction treatment programs. Though never studied, “tough love” became codified as conventional wisdom. All forms of familial support were dismissed as “enabling.”
Like many long-held beliefs about drug use and addiction, “tough love” has been accepted without scrutiny.
There is no evidence this approach helps treat addiction — but it can harm people and destabilize families. When people are shamed by their most important support networks, feelings of hopelessness and isolation only make recovery even more challenging.
But the opposite is also true: having even one person offer unconditional support can make a huge difference.
“No one ever yells at you for having diabetes or cancer or high blood pressure. And yet that’s exactly what we do to people who suffer from addiction.” — Justin S., Boulder Care Peer Coach
When one New England woman learned she was pregnant, it gave her strength to leave a physically and emotionally abusive relationship, and seek care for dependence on Percocet. Without financial resources or family support, she fought to find housing and medication treatment.
Years into treatment, she is still required to leave her young son and commute an hour every week for pill counts to “prove” she’s taking her medication. At any time, she is expected to drop everything and come in for random drug tests where a man watches her urinate into a cup, bringing back traumatic memories.
She leaves every appointment in tears.
We don’t deny insulin to people with diabetes based on what they eat. But we constantly “test” addiction patients, and threaten to discharge them for the very symptoms of their disease.
Only when patients with addiction receive the same trust and respect as everyone else can healthcare providers fulfill their promise to “do no harm.”
Some of the most widespread addiction treatment practices lack any basis in science — or directly contradict it.
The majority of rehab centers in the US (including many that are court mandated) are based on twelve-step principles — insisting upon spirituality and total abstinence as the only way to recover from addiction.
While these approaches are helpful for many, presenting any path as the only valid option is harmful to everyone who would benefit from alternatives, or who defines recovery differently.
Requiring total sobriety from all substances prevents people from getting care or learning about safer use. Evidence shows moderation is a healthy option for some — whether as a step towards abstinence, or a goal itself.
Many people won’t try medication because of misguided claims that they’re “replacing one drug with another.” Patients who are doing well with medication are often pressured to stop taking it prematurely — despite evidence that the longer people are in medication treatment, the better their outcomes.
Patients deserve objective information about different approaches (including medication and harm reduction), along with the evidence behind them and their outcomes, risks, and alternatives.
“We know how opioids affect our neural pathways, yet... insist that remission can be achieved only by replacing science and medicine with God and a support group.” Read David Poses’s The Weight of Air about the two decades he spent finding evidence-based treatment that worked for him.
People across all cultures and throughout time have used substances for medicine, religion, energy, sleep, pleasure, and relief from suffering – from the peyote cactus to alcohol to caffeine. But fundamental rights to autonomy and privacy over what we put in our bodies are threatened by ever-expanding drug laws.
Simple regulations could make substance use safer. Instead, America’s war on drugs sanctions the government taking your home, job, family, right to vote, and freedom for just possessing a substance deemed illegal at that time.
Worse, these policies are not enforced consistently or equitably; in 2019, more than 1.2 million arrests were made for simple possession, disproportionately targeting Black and brown Americans.
While many individuals still sit in prison, companies now make billions in the marijuana industry.
We must decriminalize personal substance use and begin to repair the immense damage caused by punitive, inequitable drug policies.
“We couldn't make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. Did we know we were lying about the drugs? Of course we did.” — Dan Baum, top Nixon aide and author of Smoke and Mirrors: The War on Drugs and the Politics of Failure (1996)
Since the 1960s, Americans have been manipulated and misled about substances by policies seeking political control, not public health.
The 1980’s “Just Say No” campaigns inform today’s drug education and prevention, reaffirming that all drugs are dangerous and always lead to bad things.
These scare tactics have not discouraged societal interest in drugs. Instead, they make it impossible to calculate risk or learn how to use substances safely.
As Carl Hart suggests in Drug Use for Grownups, if you were interested in driving but could only find information about catastrophic car crashes, how could you buy a safe car or learn to drive safely?
We deserve honest, objective information that empowers us to make informed decisions, rather than punishes us for personal choices.
It’s common to discuss recovery in terms of substance use — whether someone is “sober” or not. But the Substance Abuse and Mental Health Services Administration (SAMHSA) revised their definition to not mention substances at all:
“Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.” — SAMHSA
Improved health and wellness means different things to different people at different times: abstaining from all substance use, reducing or stopping use of some substances but not others, or using more safely.
Recovery need not be about substance use at all. Recovery might mean picking your kids up from school on Friday and waking up to play on Saturday morning, having a roof over your head each night, or finding work that is energizing and fulfilling.
When one-size-fits-all recovery programs fail to consider the goals of the people they’re designed to help, they are neither relevant nor responsive to the needs of their patients.
But when people define and design their own recovery, their treatment goals are more motivating and sustainable — and they thrive.
Many addiction treatment programs are confrontational, stigmatizing, and punitive — justified as correcting the supposed “character flaws” of people with addiction and explicitly attempting to further “break them down.”
These practices are still taught, despite four decades of research failing to show positive outcomes, and showing significant evidence of harm.
While most areas of healthcare promote patient empowerment, patients with addiction are told they must “surrender as powerless” and hit “rock bottom” before they can be helped.
Treatment programs wield unchecked power over patients' lives, under the premise that those who disagree are “in denial,” “non-compliant,” and can’t be trusted — despite documentation of rampant abuse and perverse incentives.
In contrast, strengths-based approaches focus on what is going well — offering empathy and encouragement and recognizing patients’ inherent capacity for good.
As Boulder Care Peer Coach Ronny B. describes: “We go on this journey. We let them know: Hey, you’re not alone. We can do this. You can do this.”
Watch Ronny’s story:
American drug policy causes more deaths than drugs do.
The failed war on drugs has cost the US over $1 trillion without making society safer, healthier, or stronger. Most federal funding for drug intervention doesn’t help people who use drugs. Instead, it funds law enforcement, surveillance, and incarceration. An estimated 65% percent of incarcerated individuals have a substance use disorder.
These policies exacerbate inequalities and racial injustice. According to the ACLU, prosecutors are twice as likely to pursue a minimum mandatory sentence for Black people than for white people charged with the same drug-related offense. White Americans are far more likely to be treated for addiction with medications, while people of color are punished for drug use.
Once arrested, people who use drugs face inhumane forced withdrawals, and can rarely access evidence-based treatment. Overdose rates are rising in prisons and jails. Post-release, overdose fatalities are 40 times higher.
But some have begun to advocate for new solutions:
“[The] belief that the fear of punishment will lead to positive change has been pervasive within the criminal justice system for the last 30+ years. It does the opposite: it creates hopelessness and disconnects people from the services that help. I realized I was doing things that were harmful — I was part of the problem. Now I’m working on solutions and helping others in criminal justice move beyond barriers.” — Jeremy Hubbard, former Senior Deputy Parole & Probation Officer
Read our interview with Hubbard on how justice system reform can save lives and make communities safer.