Resolution on Supporting Those Affected by the Opioid Crisis

Submitted by the Commission on Social Action


The Misheberach L’cholim, the Prayer for the Sick, asks for the healing of the body as well as the soul. Jewish tradition has long maintained that we are obliged to partner with God to help in the act of healing. Deuteronomy commands that every individual “shall indeed guard [their] soul[s]” (4:15). Leviticus reminds us that this commitment extends beyond the role of the individual, with the directive to “not stand idly by while your neighbor’s blood is shed” (19:16). Our tradition also teaches the danger of stigmatizing members of the community, as we learn in Pirkei Avot: “Do not disparage anyone, and do not shun any thing. For you have no person who does not have their hour, and you have no thing that does not have its place” (4:3).

The Reform Movement has also long understood the need to address substance use disorder (SUD; until recently termed “substance abuse”) and mental health within our congregations and the broader communities of which we are a part. URJ Resolutions including “Drugs” (1971), “Substance Abuse” (1989), “Dealing with Substance Abuse” (1993), and “Establishing a Comprehensive System of Care for Persons with Mental Illness” (2001) and CCAR resolutionsincluding “Drug Trade and Drug Legislation” (1993), “Establishing a Comprehensive System of Care for Persons with Mental Illness” (2001), and “Syringe Exchange Programs” (2001) have spoken to the need for improved care and treatment and reflect the ongoing evolution in the ways these issues are viewed and addressed in law and in our communities. Decades of URJ and CCAR resolutions have also addressed related issues of health care access, racial justice, and care for children.

These lessons and history are foremost in our minds and hearts as we face a continent-wide opioid epidemic. Preliminary data suggests that over 68,000 Americans died from drug overdose in 2018[1] with a majority involving opioids.[2] In comparison, in 1995 at the height of the HIV/AIDS epidemic, 43,000 people died from the virus.[3] Canada’s nearly 4,000 opioid-related deaths in 2017 reflects an equally daunting challenge.[4] 

Opioids are drugs used to treat pain. They are naturally found in the opium poppy plant and also made by scientists in labs.[5] This includes prescription drugs like hydrocodone and oxycodone as well as illegal drugs like heroin. Opioid medications are a crucial part of pain relief for many patients with serious illnesses and continue to play a vital role in pain management. However, they also pose serious risks for abuse. In the 1990s and 2000s, the opioid prescribing rate increased dramatically, eventually peaking in the United States and Canada between 2010-2012, and declining modestly since.[6, 7] Unfortunately, many prescription drug users have transitioned to using heroin and other illicit drugs, which increasingly are laced with highly potent synthetic opioids like fentanyl. This helps explain the enormous increase in opioid-related drug overdoses and deaths over the last several years.

The causes of the opioid crisis are diverse, including pharmaceutical companies’ aggressive sales tactics, over-prescription of opioids by doctors, the ease of purchasing illicit drugs, stigma associated with seeking help, ongoing economic dislocation, and a broken criminal justice system that prioritizes punishment over treatment.[8, 9]

The effects of the epidemic also go far beyond the individual level. Children of opioid users often experience long-term health effects and trauma related to their parents’ substance abuse disorder, particularly children suffering from neo-natal abstinence syndrome[10] and the overwhelming number of children who enter the foster care system due to the opioid crisis.[11] Family and friends of opioid users face continual emotional upheaval as well as financial challenges from helping their loved ones. Educational, public health, and law enforcement resources are diverted from other important issues in areas where the opioid crisis is most severe. Patients may also be denied needed, responsible opioid prescriptions by physicians concerned about changing societal views.

As with mental illness, the ongoing stigma surrounding opioid addiction also informs the way that local, state, provincial, and federal governments have responded to the opioid crisis and previous drug-related crises. For decades, the U.S. government addressed drug use and overdose primarily as an issue of criminal justice, rather than public health. The “war on drugs” focused resources and attention on suppliers of illicit drugs, demonized drug users, and unjustly targeted communities of color. These factors contributed to the high levels of drug-related incarceration in the U.S. and made it harder for those with SUD to find treatment, health care, jobs, and stable housing. Canada’s incarceration rate, far lower than the United States’, is 18th among the 36 OECD countries.[12] Canada’s approach to drug use diverges substantially from the U.S., including the recent national legalization of marijuana[13] and permitting the use of safe injection sites and heroin-assisted treatment to minimize the likelihood of overdose.[14] Many harm reduction advocates have praised these measures but contend that further reform is necessary.[15]

Evidence-based treatment and new tools can help prevent and address addiction and decrease fatal overdoses. Harm reduction strategies such as needle exchange programs have demonstrated enormous benefits.[16] Medication-assisted treatment (MAT), a form of treatment that combines FDA-approved opioid-based medication with counseling and behavioral therapy, is recognized as the gold standard for treatment, minimizing the likelihood of relapse as well as some of the painful side effects of withdrawal.[17, 18] Diversionary programs that divert those with SUD to treatment instead of prison minimize the number of individuals who are incarcerated instead of receiving treatment. Opioid reversal mechanisms such as the drug naloxone have proven very successful at preventing deaths. Forty states and the District of Columbia have “Good Samaritan” laws that protect individuals reporting drug overdose from criminal prosecution and help increase overdose reporting.[19] The SUPPORT for Patients and Communities Act, signed into law in October 2018 by U.S. President Donald Trump, made progress in addressing the crisis, including expanding access to inpatient care for those on Medicaid and increasing efforts to block mail orders of illicit drugs. However, the bill does not provide comprehensive access to treatment, particularly for medication-assisted treatment, a critical shortfall.[20]

In the U.S., federal programs such as Medicare, Medicaid, CHIP, and the Affordable Care Act play a role in addressing the opioid crisis and supporting those with SUD.[21, 22, 23] For these reasons, experts have advocated for the expansion of Medicaid[24] and opposed the imposition of work requirements on Medicaid participants.[25]

Many Reform Movement congregations are helping confront the opioid crisis in their communities by providing pastoral care; convening the expertise of doctors, nurses, socialworkers, and therapists within the synagogue; and supporting family members of those with SUD. There is an urgent need for them to continue to do so, and to further commit to finding solutions that will heal individuals, families, and communities in need.

THEREFORE, the Union for Reform Judaism resolves to:

1. Advocate for the importance of addressing substance use disorder—and the opioid crisis in particular—as a matter of individual and public health, and not as an issue of criminality for affected individuals;

2. Engage congregations and leaders across the URJ to end the stigma around substance use disorder and the opioid crisis by recognizing substance use disorder is a medical condition;

3. Urge governments and law enforcement at all levels to:

a. Support the use of evidence-based approaches for opioid use and help those with substance use disorder to minimize harm and find treatment most conducive to long-term recovery, particularly medication-assisted treatment;

b. Increase the availability of opioid reversal medication such as naloxone and protect those who report overdose from criminal prosecution related to drug use and possession, for example, through “Good Samaritan” laws;

c. Expand access to government-funded programs such as Medicare and Medicaid as well as housing and other support services and authorize these programs to provide comprehensive, evidence-based treatment and support for those with substance use disorder;

d. Authorize funding in line with the magnitude of the crisis that will effectively address the increase in substance use disorder and overdoses and provide evidence-based treatment and other supports;

e. Craft policies that balance the desire to limit prescription opioid abuse and recognize the legitimate needs of patients in pain, which can often be treated with opioids, and support research for non-addictive pain management; and

f.    Respond to the opioid crisis deliberately and equitably with regard to race, gender, or other identity characteristics and ensure that the response does not adversely affect communities of color;

4. Encourage Reform congregations and institutions as well as lay and professional leaders to:

a. Educate their members about substance use disorder and its warning signs, including partnering with organizations and individuals in their communities addressing SUD;

b. Include medications such as naloxone to block the effects of opioids in the event of overdose in their emergency preparedness kit.

c. Affirmatively support individuals living with substance use disorder and their family members;

d. Develop age-appropriate resources for addressing the crisis; and

e. Advocate for policies at the local, state, provincial, and federal level consistent with the positions outlined in this resolution.

Read the Q & A for this proposal

[1] Provisional drug overdose death counts. Center for Disease Control. September 11th, 2019

[2] Drug Overdose Deaths Finally Dropped in 2018, Preliminary Data Say. TIME. July 17th,2019

[3] AIDS Deaths in U.S. Drop by Nearly Half As Infections Go On. New York Times. October 8th, 1998

[4] National report: Apparent opioid-related deaths in Canada. Government of Canada. June 2018

[5] What are prescription opioids? National Institute on Drug Abuse. June 2019

[6] U.S. Opioid Prescribing Rate Maps. Center of Disease Control. October 3rd, 2018

[7] Pan-Canadian Trends in the Prescribing of Opioids, 2012 to 2016. Canadian Institute for Health Information. 2017

[8] Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. AJPH. February 2018

[9] Study On Opioids, Criminal Justice System Highlights Need To Have Law Enforcement Engaged In Fighting Crisis. Kaiser Health News. July 9th, 2018

[10] Children of the Opioid Epidemic. New York Times. May 9th, 2019

[11] The Foster Care System Is Flooded With Children Of The Opioid Epidemic. NPR. December 23rd, 2017

[12] Incarceration rates in OECD countries as of 2019. Statista. May 20th 2019

[13] Legalizing Recreational Marijuana, Canada Begins a National Experiment. New York Times. October 17th, 2018

[14] Canada offers places for addicts to shoot up safely. Can the US copy the model?. The Guardian. June 23rd 2017

[15] What do we mean when we talk about the drug problem in Canada – a society where a robust market in both legal and illegal substances exists, and where the use of a wide range of drugs has become common place?. Canadian Drug Policy Coalition.

[16] DC Needle Exchange Program Prevented 120 New Cases of HIV in Two Years. George Washington University Public Health. September 3rd 2015

[17] Medication- Assisted Treatment. US Department of Health and Human Services. September 9th 2019

[18] How Geisinger, Boston Medical Center, and more are implementing the 'gold standard' for opioid use disorder. Advisory Board. April 27th 2018

[19] Good Samaritan Fatal Overdose Prevention Laws. Drug Policy Alliance

[20] In Rare Bipartisan Accord, House and Senate Reach Compromise on Opioid Bill. New York Times. Sept. 26, 2018

[21] The Opioid Epidemic and Medicaid's Role in Facilitating Access to Treatment. KFF. May 24th 2019

[22] The Role of Community Health Centers in Addressing the Opioid Epidemic. KFF. July 30th 2018

[23] CMS Roadmap for Fighting the Opioid Crisis. Center for Medicare and Medicaid Services. March 2019

[24] Medicaid Expansion Dramatically Increased Coverage for People with Opioid-Use Disorders, Latest Data Show. Center on Budget and Policy Priorities. February 28th 2018

[25] Taking Away Medicaid for Not Meeting Work Requirements Harms People With Substance Use Disorders . Center on Budget and Policy Priorities. March 14th 2019