We can do better at fighting opioid epidemic

The United States makes up only five percent of the world’s population but consumes 80 percent of the world’s opioid painkillers. Currently, 175 Americans die each day from opioid overdoses. In response to this growing crisis, this year will mark a new era of American drug policy and hopefully the beginning of the long-awaited national effort to curtail our deadly opioid epidemic. Congress’ bipartisan Heroin Task Force has assembled seventeen new laws covering seven areas of opioid intervention. They include expanding access to addiction treatment, abuse prevention, improved technologies for detecting illegal opioids, safe prescription practices, thwarting prescription fraud and developing improved pain management treatments. It will require a massive effort to end this crisis and halt the destruction to our families, communities and the nation as a whole.

I am a pharmacologist, I study and develop drugs to treat difficult diseases. Along with everyone who has lost someone to this epidemic or knows someone who is grappling with opioid addiction, I am heartbroken. I am also disturbed that the policies put in place to protect us from this very crisis were intentionally undermined even as the crisis grew. Thus, I can’t help but harbor some suspicion of a Congress engaging in such an ambitious plan with widespread impacts to our lives and yet few of our elected representatives have any professional healthcare experience and none have any experience with coming up with more effective treatments for complex diseases and conditions, such as pain and addiction.

We have a massive drug problem that is killing more Americans every day. The unfortunate truth is, we don’t have a successful track record of getting drug policy right in this country. In the half-century since the Controlled Substances Act of 1970, when the term ‘gateway drug’ was dogmatically applied to cannabis as the slippery slope to heroin addiction, it has taken a deadly opioid epidemic for the realization the gateway drugs to illegal opioids came from legal prescribed opioids.

We have existing options for combatting the destructiveness of the opioid epidemic. Cannabinoids (the active ingredients in cannabis) include two major cannabis chemical variants, psychoactive tetrahydrocannabinol (THC) and non-psychoactive cannabidiol (CBD). These compounds were improperly scheduled together as a Class I drug as part of Nixon’s war on drugs. This classification marked cannabis as a highly erous drug with high abuse potential and little medicinal value. These assertions have largely been debunked by scientific evidence. Cannabis, indeed, has diverse medical properties, the likes of which researchers are just scratching the surface of. Nonetheless the classification persists.

Cannabis was never the cause of our opioid problems. Now it may help resolve the opioid epidemic we are in the midst of. Some of the most common physician visits in the U.S. are pain-related. This helped fuel the opioid epidemic. However we still lack the appropriate tools in the medical toolkit to transition suffering patients to something other than opioids. And while the search for newer non-addictive painkillers continues, forty-five states have exercised state’s rights to create medical cannabis programs. The emerging impacts on pain management and opioid use are quite compelling. In clinical medicine, it is being observed that cannabinoids (THC and/or CBD), can work as an opioid replacement, or in combination with opioids for pain management. This has resulted in lower overall need for either drugs. We are starting to see a correlating drop in opioid-related deaths in states with medical cannabis programs, the first glimmer of hope in this devastating crisis. Veterans have been hit especially hard by the opioid epidemic and overmedication. In response, an overwhelming eighty percent of American Legion veterans voted for a federal medical cannabis program. They are clearly telling us they know what does not work, they want something that does.

I am profoundly hopeful we can solve this epidemic and start saving lives. If we take careful consideration of our past and current tragic failures in drug policy, use evidencebased healthcare and intervention strategies to guide us we will find the wisdom to realize some solutions to this deadly epidemic are not as far off or as challenging as they seem.