Facing Opioids in the Shadow of the HIV Epidemic

With two colleagues, Sim Kimmel MD and Jennifer Flynn Walker, I recently wrote a letter to the editor of the New England Journal of Medicine. It was not published, so I include the text below.

To the Editor:

Parker et al (Jan 3 issue) argue that the community activism crucial to expanding access to antiretroviral therapy is needed now to address the opioid overdose crisis. In particular, the history of AIDS Coalition to Unleash Power (ACT UP) is one of civil disobedience to fight stigma, influence the research agenda, improve access to antiretrovirals, reduce the expense of treatment and maintain the experiences of people with HIV at the center of the response. To reverse the opioid crisis, similar activism and is urgently needed. Though we know of effective interventions (naloxone distribution, syringe exchange services, low barrier access to effective medications to treat opioid use disorder, including in prisons and jails), they are not widely available. There are no above ground supervised injection facilities in the United States despite robust evidence.  Community groups like Voices of Community Activists and Leaders (VOCAL-NY) and unions of people who use drugs are needed to ensure clinicians, public health experts, and politicians follow the evidence and respond to the needs of people with addiction.

1) Parker C, Hirsch J, Hansen H, et al. Facing Opioids in the Shadow
of the HIV Epidemic. N Engl J Med 2019; 380:1-3
2) Wright, J. Only Your Calamity: The Beginnings of Activism by and
for People With AIDS. Am J Public Health. 2013 October; 103(10):
1788–1798.

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