Doubling Down on the Drug War Will Only Make the Opioid Crisis Worse
It is simplistic—and thus provides an easy target—for politicians and the media to latch on to the false narrative that greedy pharmaceutical companies teamed up with lazy, poorly-trained doctors, to hook innocent patients on opioids and condemn them to a life of drug addiction. But this has never been the case.
Despite the fact that the government’s own numbers have shown for years that the overdose crisis is primarily the result of nonmedical users seeking drugs in the black market created by drug prohibition, policymakers seem intent on seeing doctors treating patients in pain as the source of the opioid overdose crisis. And their focus has been on getting doctors to curtail prescribing opioids.
As prescriptions continue to decrease, overdose deaths continue to increase. This is because as non-medical users get reduced access to usable diverted prescription opioids, they migrate to more dangerous fentanyl and heroin.
Meanwhile, a lot of patients, in and out of the hospital, suffer from under-treatment of pain.
The DEA, which sets national manufacturing quotas for opioids, ordered a 25% reduction in 2017 & 20% again this year. As a result, hospitals across the country are facing shortages of injectable morphine, fentanyl, and Dilaudid (hydromorphone), and trauma patients, post-surgical patients, and hospitalized cancer patients frequently go undertreated for excruciating pain. The shortage is uneven across the country. Some hospitals are feeling the shortage worse than others, but it’s clear that the “war on opioids” being waged by today’s policymakers is, in effect, a “war on patients in pain.”
Hospitals are working hard to ameliorate the situation by asking medical staff to use prescription opioid pills such as oxycodone and OxyContin instead of injectables, but many patients are unable to take oral medication due to their acute illness or post-operative condition. In those cases, hospitals use injectable acetaminophen, muscle relaxants, or non-steroidal anti-inflammatory agents, but those drugs fail to give adequate relief. Some hospitals have even resorted to asking nursing staff to manually combine smaller-dose vials of morphine or other injectable opioids that remain in-stock as a replacement for the out-of-stock larger dose vials. Dose-equivalents of different IV opioids vary and are difficult to accurately calculate. This increases the risk of human error and places patients at risk for overdose.
In another misguided attempt to reduce opioid use, abuse, and overdoses, policymakers have also focused on developing and promoting tamper-resistant or abuse-deterrent formulations (ADFs) that render diverted opioids unusable if individuals attempt to use them for nonmedical purposes.
Although the benefits of ADFs seem to be nonexistent, these formulations have led to real harms. ADFs have encouraged users to switch to more dangerous opioids, including illegal heroin. In at least one instance, the reformulation of a prescription opioid led to a human immunodeficiency virus (HIV) outbreak. Along the way, ADFs unnecessarily increase drug prices, imposing unnecessary costs on health insurance purchasers, taxpayers, and particularly patients suffering from chronic pain.
Meanwhile, the CDC’s methods for tracking opioid overdose deaths have over-estimated the number of those deaths due to prescription opioids, as opposed to heroin, illicitly manufactured fentanyl, and other illicit variants of fentanyl. The exact drugs involved in overdose deaths are not identified in 20% of death certificates, multiple drugs are involved in over half of their reported cases of prescription opioid overdoses, and the number of deaths due to diverted (stolen, smuggled, or sold by dealers) prescription opioids is unknown.
Unfortunately, the Trump Administration’s response has been disappointing at best.
President Trump sees the zero-tolerance policies of Singapore, China and the Philippines as a model for U.S. drug policy. Even worse, Trump is said to believe that all drug dealers should get the death penalty.
The president’s frustration with the failure of the war on drugs is understandable. But the solution should not be to try more of the same, only “tougher.” Threats of increased prisons sentences — or even death sentences — amount to nothing more than a temper tantrum.
Sensible drug policy makes it easier for people with substance abuse problems to transition back to a normal life, rather than ruining their lives through long-term incarceration — or ending them altogether through capital punishment. If the goal is reducing drug-related deaths, policymakers should put more emphasis on “harm reduction” measures, such as syringe services programs, medication-assisted treatment with drugs such as methadone, buprenorphine, or naltrexone, and enhanced distribution of naloxone, the antidote for an opioid overdose. These programs not only reduce deaths but are a more cost-effective allocation of resources.
