Declare opioid ‘state of emergency’
One thousand people a week die of drug overdoses in America. Where’s the outrage?
If 1,000 people in America were dying in plane crashes or terrorist attacks each week, the country would be horrified, demanding an end to the carnage.
Well, 1,000 people are dying each week of drug overdoses, driven largely by addiction to opioids. Yet outside of pleas from victims’ loved ones and addiction experts, there is no sustained, massive outcry across the nation to stamp out this scourge.
Perhaps the raging epidemic has failed to galvanize the public because the deaths don’t occur as mass tragedies. They are spread across the country, a relentless stream in cities, suburbs, small towns and rural communities.
Overdose deaths — more than 52,400 in 2015 — have far outstripped the toll from guns or vehicle crashes, once the leading causes of accidental deaths. This tragedy is a health crisis that requires an all-out response by all levels of government, law enforcement, the medical establishment and the treatment community.
On Monday, a commission created by President Trump called for the president to declare a “national emergency,” which would empower federal agencies to take bold steps and cut through regulatory hurdles, pressure Congress to provide more money for the fight, and awaken more Americans to the extent of the the crisis. Several public health experts made a similar recommendation to the Obama administration last year, but nothing came of it.
The commission also called for more concrete actions, including changing federal law to force licensed physician prescribers to get training on how to prescribe opioids safely. Amazingly, few get such training now.
Most of the panel’s recommendations are solid and deserve to be adopted. But one excellent idea — eliminating a major barrier to using federal Medicaid funds for drug treatment at large psychiatric hospitals — runs head-on into Republican efforts to curb Medicaid spending.
Whether the president moves on this proposal will say a lot about how serious he is about solving this crisis.
Any comprehensive approach must include ways to treat those who are already addicted, and steps to prevent addiction in the first place.
Addicts are showing up in morgues, at a rate so high in some communities that coroners are running out of space. But many victims who die have shown up previously in emergency rooms before it was too late. Most are told they need treatment and are handed a list of facilities to call the next day. Few follow up, and even when they do, effective treatment is hard to find.
A groundbreaking 2015 Yale University study found that patients given buprenorphine — an opioid replacement drug that can be taken safely under a doctor’s care — in the emergency room were twice as likely (78% to 37%) to stay in treatment 30 days later compared with those who just received a referral.
Wider adoption of medicationassisted treatment has been hindered by the stigma attached to opioid addicts, who are seen as people with moral failings rather than as patients with serious medical conditions.
Medications can, of course, be subject to abuse or diversion. But evidence shows that these treatments are more successful than talk therapy alone, and they should be more widely available as part of recovery programs. Right now, only about 10% of treatment facilities provide medication-assisted treatment.
As for preventing opioid addiction, that will be largely up to federal agencies that for years made it far too easy to prescribe painkillers and the doctors who prescribed them cavalierly. In 2012, doctors wrote 282 million prescriptions for opioid pain medication, more than enough for every adult in the USA to have a bottle of pills. Didn’t anyone notice that something was terribly wrong with this huge number?
Now the country is living with the consequences of those failures. Many addicts who can no longer get opioid prescriptions legally, or find the drugs too expensive on the street, have turned to heroin, which is cheaper and widely available. Heroin overdose deaths have more than tripled since 2010.
Some dealers are lacing heroin with synthetic fentanyl and other dangerous drugs to provide a better high — combinations that are proving deadly. This is a law enforcement problem requiring a concerted effort to trace and arrest the suppliers of deadly synthetic opioids.
New approaches are urgently needed. It would not be all that difficult for the Trump administration to exceed the performance of the Obama and Bush administrations, both late to recognize this horrific crisis.
The impetus certainly exists: If today is an average day in America, drug overdoses will kill another 144 people.