How to end the opi­oid cri­sis in seven steps

Milwaukee Journal Sentinel - - Crossroads - Michael R. Bloomberg

The opi­oid epi­demic is now a full-blown na­tional cri­sis, yet the fed­eral govern­ment con­tin­ues to daw­dle. Pres­i­dent Don­ald 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 worse.

Opi­oid over­dose deaths rose 28% in 2016, to 42,000 men, women and chil­dren. About 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 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 non-ad­dic­tive 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 — but 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. CVS Care­mark has moved to limit cov­er­age for opi­oid pre­scrip­tions. Oth­ers should fol­low its lead. These com­pa­nies ex­ist to help peo­ple lead bet­ter, health­ier lives, and they should not be com­plicit in an ad­dic­tion and over­dose epi­demic.

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.

Lo­cal gov­ern­ments have filed nearly 200 law­suits against man­u­fac­tur­ers and dis­trib­u­tors. They de­serve their day in court, but we can­not pin our hopes on the out­come. 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. Many politi­cians wrongly be­lieve that pro­vid­ing methadone or other opi­oid-based treat­ment to peo­ple al­lows them to get high. In fact, when used as part of treat­ment pro-

grams, these med­i­ca­tions ad­dress the symp­toms of crav­ings and phys­i­cal with­drawal with­out pro­vid­ing the eu­pho­ria of il­licit drug use.

The stigma­ti­za­tion of med­i­ca­tion is es­pe­cially prob­lem­atic for our crim­i­nal jus­tice sys­tem. Each year, about onethird of heroin users spend time locked up, yet the fed­eral govern­ment, and the vast ma­jor­ity of states and lo­cal­i­ties, do not of­fer them med­i­ca­tion-as­sisted treat­ment while they are be­hind bars. That treat­ment, when linked to ad­dic­tion ser­vices af­ter re­lease, boosts the odds of putting their lives back to­gether and re­duces the like­li­hood that they will re­turn to crime.

State and lo­cal gov­ern­ments can do more. The fed­eral govern­ment should in­cen­tivize cities and states to of­fer treat­ment to in­mates, 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. Ex­ist­ing sta­tis­tics on mis­use and over­dose are out of date and of­ten in­ac­cu­rate. In many com­mu­ni­ties, rel­e­vant data is gath­ered only when peo­ple are ar­rested, or when they die from over­doses — or not at all. 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 — “He will do some­thing about it,” Trump said prior to the meeting. 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. Govern­ment by sym­bol­ism — whether build­ing a wall or declar­ing an emer­gency — doesn’t solve real prob­lems.

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.

Michael R. Bloomberg, the for­mer mayor of New York City, is the founder and ma­jor­ity owner of Bloomberg LP, the par­ent com­pany of Bloomberg News. He is the UN sec­re­tary-gen­eral’s spe­cial en­voy for cities and cli­mate change.

EURO­PEAN PRESS AGENCY

Pres­i­dent Don­ald Trump signs a bi­par­ti­san bill Wed­nes­day to stop the flow of opi­oids into the United States.

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