25 Years On, Still Needed: Why Overdose Deaths Are a Continuity Problem

International Overdose Awareness Day — August 31

T.H. & Associates  ·  Behavioral Health · Telehealth  ·  Virginia · Washington, DC · Maryland

Dr. Tierra Hereford

International Overdose Awareness Day turns 25 today. The theme is “25 Years On. Still Needed.”

That phrasing is doing careful work. It acknowledges a quarter century of real progress — naloxone in ordinary hands, medications for opioid use disorder, a public conversation that has moved meaningfully away from treating addiction as a moral failing. And it refuses to pretend the work is finished.

I want to write about a specific part of why it isn’t finished, because it gets less attention than it deserves. It isn’t that we don’t know what works. We do. The problem is that the things that work are scattered across systems that don’t hand people off to one another.

People aren’t falling through cracks. They’re falling through gaps we built.

The bottleneck is real, and it has a shape

Every transition is a place someone can disappear.

Think about what actually happens after a nonfatal overdose.

Someone survives — often because a bystander had naloxone. They may or may not go to an emergency department. If they do, they are stabilized and, in many cases, discharged within hours, sometimes with a list of phone numbers. Then they are expected to independently navigate an intake process at an agency they’ve never contacted, during business hours, while in withdrawal, often without a phone that works or a ride that shows up.

That period immediately following a nonfatal overdose is one of the highest-risk windows in all of behavioral health. It is also, in most systems, the moment when supervision drops closest to zero.

This is what I mean by a continuity problem. Every one of those transitions is a place where someone can vanish from care entirely — not because they refused help, but because the help required more navigation than a person in crisis can perform.

Access isn’t the same as availability

A service can exist and still be functionally unreachable.

Waitlists outlast willingness. The window in which someone is ready to start treatment is often measured in hours. When the first available intake is three weeks out, the service technically exists. It just wasn’t there when it mattered.

Referral is not transition. Handing someone a phone number transfers the entire burden of follow-through to the person least resourced to carry it. A warm handoff — a real person making a real connection — produces very different outcomes than a printed list.

Hours and geography exclude people quietly. Programs that operate 9 to 5, in one location, reachable only by car, have made an access decision whether or not they framed it that way.

Every re-telling costs something. When systems don’t communicate, people repeat their history at every door — to intake staff, to a nurse, to a counselor, to a new agency. For someone with a trauma history, that is not a neutral administrative step. It is a reason to stop showing up.

None of this is a criticism of the people doing the work. It is a description of what happens when services are funded and licensed separately and expected to function as a system anyway.

What closes the gap

The interventions are not mysterious, and they are not new. What they require is that someone build the connective tissue between them.

***Naloxone in ordinary hands. Not just in clinical settings — with families, coworkers, neighbors, and the people most likely to be present. In Virginia, REVIVE! is the Commonwealth’s opioid overdose and naloxone education program, and the training is free and open to the public. I am REVIVE!-certified and I would encourage every clinician, and frankly every person, to complete it. It takes about an hour and it is the single most direct thing a bystander can do.

***Peer recovery specialists. This is the workforce gap I would most like to see closed. A peer recovery specialist — someone with lived experience of recovery, trained and credentialed — can meet a person at the bedside in the hours after a reversal and stay with them through intake. That is precisely the bridge that’s missing, and the evidence for it is strong. Virginia has built the credentialing pathway. What we don’t have is enough people in the role, or enough organizations positioned to bill for and sustain it.

***Same-day and low-barrier access. The willingness to start does not wait three weeks. Programs designed around when people are actually ready — rather than when the calendar has an opening — catch people the standard model loses.

***Care that follows the person. Across settings, without restarting at every door. This is unglamorous infrastructure work: releases of information, shared documentation, an actual human responsible for the handoff.

***Language that doesn’t push people away. Substance use disorder is a treatable medical condition. Stigma is not a soft concern — it is a measurable barrier to treatment entry, and it is the one every single person reading this can address today at no cost.

What this day is also for

International Overdose Awareness Day is not only about prevention. It is about remembrance: and about a form of grief that rarely gets the room it needs.

Families who lose someone to overdose often grieve quietly, because of what the world attaches to how their person died. The casseroles don’t arrive. People don’t ask. The loss carries a layer of judgment that other losses don’t, and the person grieving frequently absorbs it as their own failure.

If that is you, today exists for you too. Your grief is not complicated by how they died. It is complicated by how other people responded to it.

Behind every number in this conversation is a person somebody loved.

If you need help today

Overdose is preventable. Substance use disorder is treatable. Nobody has to earn the right to be helped.

• SAMHSA National Helpline — 1-800-662-4357. Free, confidential, 24/7, in English and Spanish. They can connect you to local treatment and support.

• 988 — call or text, anytime, for crisis support.

• REVIVE! — Virginia’s free opioid overdose and naloxone education program, open to the public through DBHDS and local community services boards.

T.H. & Associates provides telehealth behavioral health care across Virginia, Washington DC, and Maryland.