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Opioids in America


We constantly hear about the “opioid epidemic”—the worst drug crisis in the history of the U.S. By 2020, the epidemic could have claimed over a million lives. According to the Center for Disease Control (CDC) over a hundred Americans die from drug overdoses every day, as many as die gun-related deaths. And yet, on Facebook, I see no profile picture changes in response to this catastrophe, of the sort that follow any mass shooting. During the AIDS epidemic, Americans marched the streets in protest. These shows of solidarity are valuable insofar as they can inspire a public policy response. I am curious as to why, on the large, reactions to the opioid epidemic have been—comparatively—much quieter, because government action is urgently needed. 


The Flawed Response


This is not to say that the government has been silent. Not long ago, President Trump deemed the epidemic a national Public Health Emergency. In June, the House passed extensive legislation with up to 58 bills to enhance addiction treatment and crack down on the illegal opioid market; it is the most comprehensive package dealing with opioids to date, and a remarkable step forwards (although some critics, like Frank Pallone (D), say it doesn't go far enough).


But the legislation has stalled. Let’s look at the Senate: why the wait on the floor vote? This is a package with incredible bipartisanship support, one that surely would pass, and yet it seems like Mitch McConnell may be stalling the vote for political purposes. Since there are several Senate Democrats up for reelection in states heavily affected by the opioid crisis, the theory is that Republicans don’t want to give those Democrats a bipartisan success story to tout on the campaign trail. This is all speculation from critics, but certainly plausible given the political climate. If true, it is repugnant. And, if not, nothing changes the fact that this life-saving legislation could easily pass yet we are stillwaiting. 


While President Trump has acknowledged the issue, the Federal approach has been lacking. Federal efforts focus on reducing the over-prescription of opiates. President Trump has said he believes this will lower the overall opiate supply by a third in three years. This approach has some merit: Doctors in the US have been overprescribing opioids for years now. But to force doctors to cut back on prescriptions or else lose their license is counterproductive. Introducing draconian penalties is a simplistic approach, yet one that the Drug Enforcement Administration (DEA) is embracing. The effects of this? A pronounced rise in suicide. Moreover, these measures may not address the most pressing facet of the epidemic—80% of overdose deaths in 2016 came from non-prescribed street drugs, notably fentanyl or fentanyl-spiked heroin. 


This is not to say that the federal approach has been wholly disastrous. The DEA is doing a solid job on cracking down fentanyl distribution. DEA agents recently caught a Mexican couple at an apartment in New York City with enough of the drug to kill 32 million people. (It should be noted that these distributors fly from Mexico and tend to have no criminal record, so perhaps a wall isn’t the best response.)


A Better Way


Despite the DEA’s efforts, the fact is that disastrous amounts of fentanyl continue to plague the US. The federal government should redirect some of its focus toward the patient rather than the pill supply. Instead of merely preemptive measures, more emphasis is needed on addiction treatment: a strong example is Vermont’s “Hub and Spoke” program, through which addicts come to receive help and care. The “Hubs” offer intensive, more urgent medical treatment, and are usually where patients are first directed; the “Spokes” provide ongoing, more community-oriented treatment and follow-up care. Started by Doctor John Brooklyn in 2009, the program was (and still is) subsidized via a Medicaid waiver: it has been well-received by both providers and patients, and has successfully reduced opioid abuse. Vermont’s success is especially apparent when compared to its neighbor New Hampshire, which in 2015 suffered twice as many overdose deaths.


Trump has called this a “world crisis”, but in fact it is not. France offers another positive example from which the US can learn. In the 1990s, the French government loosened restrictions on doctors prescribing buprenorphine, which is considered the gold standard for opioid care. (Buprenorphine is itself an opioid: it binds to opioid receptors but to a lesser degree, thus not producing a high but staving off cravings and withdrawal). Opioid overdoses in France then decreased by 79% in four years. This crisis is particularly American, in its scope and its response when compared to abroad. 


Why aren’t other states following Vermont or France? Part of the reason is the persistent moral stigmatization of addiction, a relic of the War On Drugs. But the outlook is improving. Thirty years ago, the “solution” to the crack epidemic was putting addicts in prison. Now, we would flinch at that response. This is reflective of a better understanding of addiction, one that treats it as a public health versus a criminal justice issue, though there is still much work to be done.


In Sum… 


At least the government has acknowledged the need for action, in contrast to its silence during the AIDS epidemic, and racist  failure to humanely address the crack epidemic. As things stand, however, the amount of opioid-related deaths is set to rise. I remind the reader that as much as America has a problem with guns, it has a problem with opioids, and it is a rather serious one, the most serious in our history. The government has the power to stop it. Ultimately, this will necessitate an active level of citizen involvement, in recognizing and fighting the problem. Washington is doing something about it—but it could, and must, do more.  

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