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The Administration's Fundamental Flaw on Opioid Addiction: Talk of Progress Is Greatly Exaggerated

23 Oct 2018

Jeffrey A. Singer

The White House plans to stage an event this week celebrating
its accomplishments addressing the opioid overdose deaths crisis.
The event will come a year after the President declared
opioid-related overdoses a national public health emergency, and a
little over a week since the Senate passed and sent to the
President’s desk a bill, H.R. 6, aimed at further combatting the problem. But
Congress and the White House have nothing to boast about. The
policies in place for the past several years, and on which the new
legislation generally doubles down, have only served to drive up
the overdose rate while making patients suffer needlessly in the
process.

Sadly, all that Congress
and the White House have to brag about is a policy that is driving
non-medical users to more dangerous drugs and causing desperate
pain patients to turn to the black market or to suicide for relief.
They should refrain from uncorking the champagne.

Last December the Centers for Disease Control and Prevention
reported that the overdose rate increased 21% from 2015 to 2016. This month the CDC
reported provisional numbers showing another
10% increase in 2017. All of this is happening despite federal and
state efforts, using practice guidelines and prescription
surveillance programs, that have led to a drop in high-dose opioid
prescribing of 41% from 2010 to 2016, and another 16% in 2017. Those same policies have
caused heroin and illicit fentanyl (largely smuggled in from Asia employing drug
cartel infrastructure
) to become the predominant causes of opioid-related overdose
deaths as non-medical users migrated over to those cheaper and more
available drugs. Yet the new legislation provides funding to
augment and enhance prescription surveillance programs.

That’s because the opioid overdose crisis was never really about
doctors treating their patients in pain. It has always primarily
been caused by non-medical users accessing drugs through the
dangerous black market that results from drug prohibition. The
overwhelming majority of those overdose victims have multiple drugs in their system when they
overdose. The New York City Department of Health reported in 2016 that three-quarters of all
overdose deaths were either heroin or fentanyl, and 97% of those
overdose victims have multiple drugs onboard - 46% of the time that
drug included cocaine. This hardly fits the profile of a patient
receiving medical treatment for pain.

This should come as no surprise to policymakers. The National
Survey on Drug Use and Health has been reporting for years that less than 25% of
non-medical users of prescription opioids ever obtain them from a
doctor. They get them from a dealer, a friend or a relative.

As a report last month by researchers at the University of
Pittsburgh Medical Center shows, death rates from drug overdoses by
non-medical users have been on a steady increase since the 1970s.
At different points in time different drugs come in and out of
vogue. In the opening years of the 21st century, the media reported
on a “meth epidemic.” In 2005, restricting Sudafed
sales along with SWAT team hits on meth labs slowed down the death
rate for about a year, and then overdoses from prescription opioids
became the new cause of concern. Heroin and fentanyl are now the
primary killers, although one should keep their eyes on meth, which
is making a big comeback. Meth deaths were up 30% in 2015
alone, as alternative production methods were developed by the drug
cartels that filled the void after home-grown meth labs were
destroyed.

Sociocultural forces drive this decades-long trend of
self-medication with licit and illicit drugs, and prohibition makes
them dangerous and deadly. You never can be sure of what you are
getting when you get it on the black market.

HR 6 throws more money toward addiction rehab programs, but not
all non-medical users are addicts, and the fear of being treated as
a criminal deters those who need help from seeking it.

Congress and the White House have their eyes on the wrong
target. If they can’t answer the hard questions surrounding
the unintended consequences of drug prohibition, they should at
least put their efforts into reducing the harm that comes from
using drugs in the black market. The just-passed legislation does
make it somewhat easier for health-care providers to prescribe
buprenorphine as a form of Medication-Assisted Treatment for opioid
addiction. But it doesn’t go far enough. It should also allow
providers to prescribe methadone in the same manner - as
they’ve done in Canada, Australia and the UK for decades.
Federal law must be changed to legalize supervised injection facilities, used
successfully in virtually the entire developed world since the
1980s, to reduce overdose deaths and the spread of infectious
diseases. And the overdose antidote naloxone should be made
truly over-the-counter, so it gets more widely
used.

Sadly, all that Congress and the White House have to brag about
is a policy that is driving non-medical users to more dangerous
drugs and causing desperate pain patients to turn to the black market or to suicide for relief. They should refrain from uncorking the
champagne.

Jeffrey A.
Singer
practices general surgery in Phoenix, AZ and is a senior
fellow at the Cato Institute.

Click here to view the full article which appeared in CATO Journal