Opioid crisis needs bold leadership, sweeping plan

The opioid epidemic is now a full-blown national crisis, yet the federal government continues to dawdle. President Trump declared opioid addiction a public health emergency, and he talks a tough game. But he has not taken forceful action. If he will not lead, Congress must — and now, before the crisis grows even worse.

Opioid overdose deaths rose 28 percent in 2016, to 42,000 men, women and children. Some 2.6 million more Americans are addicted to opioids, and communities in every region of the country are suffering from the resulting trauma. Largely as a result, life expectancy declined in 2016 for a second straight year — something that has not happened since the early 1960s.

This is a solvable problem, and through philanthropy we can make some progress. But real success requires much bolder leadership — and a far greater sense of urgency — from both elected officials and industry leaders.

We must stop doctors from over-prescribing opioids, especially when nonaddictive pain medications (such as ibuprofen or acetaminophen) would be just as effective. Steps have been taken to educate doctors and to curtail prescriptions for opioids (such as Oxycontin, Percocet and Vicodin), and the prescription rate has fallen from its peak in 2010. But it remains three times what it was in 1999 — and four times what it is in Europe.

More aggressive action is needed. The Food and Drug Administration should allow only doctors who complete specialized education in pain management to prescribe opioids for more than a few days, a move FDA Commissioner Scott Gottlieb is considering. Some states have limited the size of certain opioid prescriptions — all should do so. To avoid the need for bans or other draconian measures, which would harm people suffering the most severe chronic pain (including many who are terminally ill), the medical profession must do more to rein in prescriptions and create effective monitoring programs.

Insurers and pharmacy benefit managers must better oversee opioid prescriptions.

We must hold pharmaceutical companies accountable for the supply of prescription opioids. Like gun manufacturers that continue to supply dealers with a history of selling to traffickers, pharmaceutical companies and their distributors have a history of turning a blind eye to pill mills. The federal government must do more to monitor the supply of the drugs and crack down on companies that skirt the law.

We must stop stigmatizing the medications that have been proven to help people recover. When used as part of treatment programs, medication like methadone address the symptoms of cravings and physical withdrawal without providing the euphoria of illicit drug use.

The federal government should incentivize cities and states to offer treatment to prison inmates who are addicted, as New York City and a handful of other localities do. In addition, police need new strategies to respond to heroin and fentanyl, a deadly synthetic opioid. These include providing ready doses of naloxone (Narcan) to reverse overdoses, and offering paths to treatment for all users.

We must develop better data. Better information of all kinds could help communities, states and the federal government monitor the scope of the crisis and target interventions more effectively.

We must do more to block the importation of heroin — and of fentanyl, much of which originates in China. President Trump declared that this would be “a top priority” of his meeting with President Xi Jinping. We have yet to hear what, if any, new commitments he secured. Nor will building a wall along the Mexican border stop the drugs from entering the U.S., despite the president’s belief that it will have a “great impact” on the problem.

All of these steps come with a cost, but little effort has been made to quantify it. Local and state agencies bear most of the burden of this crisis, but no one has yet analyzed the extent of the assistance they need. That should be done before coming up with a price tag. Senate Democrats have proposed spending $25 billion without first detailing a plan. If money is to be spent effectively, it must be attached to a comprehensive plan of attack.

The number of opioid deaths for 2017 is likely to set a record. Yet it’s business as usual in Washington. In 2018, the American people must demand more — from all their elected officials.