The opioid emergency

Americans are dying for stronger leadership on nation’s most pressing public health crisis

By Rick Holmes

July 28, 2017

Americans are divided and Washington is paralyzed by partisanship. But there is one issue that knows no party, that strikes blue states and red states alike, that touches families of every race, income and educational demographic, whatever cable news channel they watch.

The death toll from America’s opioid epidemic topped 59,000 in 2016, according to a careful estimate by The New York Times.  That means more Americans died of drug overdoses last year than in the nation’s most deadly year for gun violence, 1993. More overdose deaths than in the worst year for auto fatalities, 1972. More Americans died from opioid overdoses in one year than in were killed in all the years of the Vietnam War.

That crisis galvanized national politics. This one, not so much.

In the survey of “American carnage” in his inauguration address, Donald Trump made no mention of opioid addiction. Nor did top Senate Democrat Chuck Schumer mention it in his announcement unveiling his party’s new “better deal” agenda.

Meanwhile, the crisis is getting worse, the death toll shooting ever higher. Tighter monitoring of prescription painkillers has driven more users to heroin. Growing access to Narcan, which can reverse an overdose, is saving lives, but the drugs are getting stronger and more resistant to Narcan. Fentanyl, a synthetic opioid mostly made in China, is now killing more users than heroin. The deadliest new import is carfentanil, an elephant tranquilizer 5,000 times more potent than heroin.

Overdose deaths measure just one part of addiction’s misery. We can only guess at how many lives have been ruined by their own addiction or the untreated addiction  of a loved one. We can’t measure heartache, but we can count some of its consequences: America’s suicide rate, for instance, is now higher than it’s been in 30 years.

“It’s pretty clear where the problem came from,” Gov. Charlie Baker of Massachusetts told a gathering of governors in Rhode Island this month. This epidemic started in the doctor’s office.

American physicians wrote 240 million prescriptions for opioids in 2014, Baker said. Four out of five opioid addicts started with prescription painkillers.

Baker, a former health care executive, said it pained him to conclude that it was “15 years of really bad behavior by a whole bunch of people in the clinical community who got us into this mess.”

Getting out of this mess will take persistent efforts on multiple fronts. Politicians need to stand up to the opioid-industrial complex – corporate giants like Purdue Pharma, Tevo Pharmaceuticals and Johnson & Johnson – as well as physicians who prescribe opioids when less addictive painkillers would be just as effective. We need to fund research into alternative painkillers and addiction treatment. We need to get over the abstinence-only bias in some addiction treatment policies; for many people, medication-assisted treatment works far better than “12 Steps” regimes.

We need more drug courts and less incarceration; more treatment in jails and prisons for those whose crimes are tied to their addictions. We need to rethink the drug tests that are a growing source of economic distress in many communities. Failing a drug test should open the door to treatment, not slam the door to employment.

Most of all, we need to end the stigma that blames the victim for the disease, that prevents people from asking for help, that makes parents hide the cause of death in their children’s obituaries.

For those who say it’s impossible to fix this, consider another public health crisis. Like opioid addiction, AIDS often struck young people in the prime of life. It had a behavioral element and carried a stigma. In the early years of the AIDS epidemic, politicians – notably President Ronald Reagan – wouldn’t even talk about it. Moralists said AIDS victims, mostly gay men, were being punished for their sins. Blaming the victim is nothing new.

But AIDS victims found their voice, and allies took up the cause. Public education slowed the epidemic’s spread. Publicly-funded research came up with treatments that made it possible to live with HIV and is closing in on a vaccine.

U.S. deaths from AIDS peaked at in 1995 at 41,699 and began to go down as those efforts bore fruit. The death toll was 6,721 last year, and falling.

Taming a public health crisis requires political leadership. Baker, a Republican governor of a Democratic state, made opioids a priority from the start, for both moral and political reasons. It’s a problem that transcends ideology or party affiliation, one that can bring people together.

We need to see that kind of urgency in Washington. Trump promised action on opioids during the campaign, then appointed an attorney general – still Jeff Sessions, as of this writing – who is one of the few people who still believe we can arrest our way out of the opioid crisis. He appointed a commission to study the issue, chaired by New Jersey Gov. Chris Christie, which has already missed two deadlines for producing a preliminary report.

Americans are dying for a national response to this public health emergency. When will they see it?

Rick Holmes can be reached at rick@rickholmes.net. You can follow his journey at www.rickholmes.net. Like him on Facebook at Holmes & Co, on follow him on Twitter @HolmesAndCo.