As debates rage over how we can best protect those more directly affected by climate change, one group remains absent from the discussion: people with an opioid addiction.
Around three million people in the U.S. have an opioid use disorder or are dependent on heroin. More than 100,000 Americans died of drug overdoses from April 2022 to April 2023, most of which were from illicit fentanyl opioids. Cities with high overdose rates, such as New York City, San Francisco, Calif., and Phoenix, Ariz., are also at the highest risk of extreme heat, drought and flooding, and the opioid epidemic is likely to peak just as climate change’s most brutal effects start to take root.
During environmental crises, drug users frequently experience more social and economic hardships than the rest of the population. These hardships often snowball into poor health outcomes, including death. Climate change will likely disrupt the illegal drug supply chain—making dangerous drugs even more variable and deadly. Soaring temperatures will make people more vulnerable to overdose. Despite this, drug users are typically not considered in public health efforts related to climate change preparedness. This urgently needs to change.
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Authorities must start thinking about the intersection between climate change and drug use. They must design climate literacy programs for drug users, build a housing policy that considers climate change’s impact and make harm reduction programs more widely available.
As part of the Helping to End Addiction Long-Term (HEAL) Initiative, I research various aspects of America’s ongoing opioid epidemic. Despite all the useful data the project is producing, climate change’s influence has been of little interest to researchers in the initiative or scholars in the field. It wasn’t until last year that the National Institutes of Health announced the availability of funds to support research that specifically examines the intersection between climate change and substance use. Unsurprisingly, there has been very little published on the topic, significantly limiting the opportunity to study and develop solutions to stem the unique risks that drug users face. This inertia comes as the United Nations has yet again warned of the dire need for implementable, cost-efficient solutions to climate change and after the opioid epidemic’s status as a public health emergency was renewed earlier this year. The staggering economic costs have also been overlooked: climate-fueled disasters cost the U.S. roughly $151 billion per year, while the financial impacts of the opioid epidemic land at roughly $1.5 trillion per year, about seven times the annual cost of addressing heart disease in this country.
The link between environmental disaster and drug use became clear in 2017 when Hurricane Maria caused an estimated 5,000 deaths in Puerto Rico. Amid the typical flurry of media images of flooded homes, downed power lines and uprooted trees, drug use and overdose rates dramatically increased, as did needle reuse, a key driver of HIV, which has been soaring in Puerto Rico. While groups such as older and homeless people or those with disabilities often receive special outreach and tailored resources during weather-related disasters, virtually nothing is done to formally forecast and address the needs of illicit drug users during these events. Indeed, the U.S. government’s health authorities currently provide no official guidance or support for preempting this disastrous domino effect.
Climate change will exacerbate overdose and death risk through the increasingly intricate opioid supply chain. As supplies become harder to transport, drug users, like other consumers, could see steep increases in their product’s costs and decreases in quality. More opioid users will likely switch to cheaper but far more potent and potentially lethal synthetic substances, such as fentanyl. Also, extreme heat can create a deeply sedative effect, making lethargy, muscle breakdown and dehydration worse, all of which significantly increases the risk of fatal overdose.
To get ahead of the collision course, it’s essential for public health authorities to first build greater climate change literacy among drug users. This effort must begin by providing them with tailored educational materials that highlight climate change’s core causes and consequences. Most importantly, these materials must identify drug users’ specific vulnerabilities, given their socioeconomic and geographical circumstances.
Next, we need to build climate-related emergency reserves for home maintenance programs and for rent and mortgage payment deferrals. Housing insecurity is not only intimately connected to drug use onset but also to overdose risk. America’s housing crisis—which intensified during the COVID pandemic—will deepen as property damage from extreme weather accelerates and unemployment rises. More people will be displaced and unhoused. Housing officials have implemented policies to prevent this before. During the more intense waves of the pandemic, officials turned toward eviction moratoriums, which were highly effective before they were rolled back last year.
Finally, we need deeper support for harm-reduction services and treatment such as naloxone, an emergency opioid-overdose-reversal medication, and highly effective drug treatments such as Suboxone, which are harder to obtain for people in Black and low-income communities. We can anticipate that by the early 2030s there will be an increasing need for these resources and the safety net that propels them. In addition to increasing overdose rates, a lack of investment in harm reduction will spur a rapid increase in HIV/AIDS and sexually transmitted infections.
There is no simple solution to address the intersecting crises of climate change and opioid misuse. The best-case scenario is that local governments and industry can collaborate to improve the flow of resources to drug users and those at risk of developing an opioid use disorder. The hyperstigmatization that drug users experience is likely to keep them right in climate change’s crosshairs. This is an altogether different type of pollution that is nonetheless as elusive as the one driving climate change.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.