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June 15, 2017

America’s Opiate Epidemic: Enablers and Victims

The nation faces a crisis of overdose deaths and addiction. What started it and what can we do?

Our nation is in the midst of a heroin/opioid epidemic.

Centers for Disease Control and Prevention (CDC) statistics released late last year reveal a staggering 52,404 Americans died from drug overdoses in 2015, far more than the 37,757 Americans who died in car crashes and the 36,252 Americans who died because of guns, including homicides and suicides. Preliminary data reveals more than 59,000 died of overdoses in 2016.

As Vox columnist German Lopez explains, the foundations of our current opioid crisis were laid back in the late 1990s. Pharmaceutical companies, doctors and government were all involved. Drug companies misleadingly promoted opioids to treat chronic pain, and government officials at different levels bought into that promotion, requiring insurance policies to cover the drugs. Government also pushed doctors to prescribe opioids via a “Pain as the Fifth Vital Sign” campaign run in the 1990s and 2000s.

By the time the Drug Enforcement Administration put greater restrictions on opioids in 2014, and Congress addressed the problem with the 21st Century Cures Act in 2016, more 560,000 people had died from drug overdoses between 1999 and 2015.

Purdue Pharma was one of the scourge’s principal perpetrators. Beginning in 1996, it began producing OxyContin, while misleading the public about the drug’s addictive potential. In 2007, the company’s president, top lawyer and former chief medical officer were assessed $634.5 million in fines — two days after the company agreed to pay $19.5 million to 26 states and the District of Columbia for encouraging doctors to over-prescribe a drug derisively referred to as “hillbilly heroin” for the havoc it has wreaked among rural white males.

How much havoc? “In some small towns in Kentucky and Virginia, up to 40 per cent of the adult population is hooked on OxyContin, and up to 80 per cent of crimes are related to the drug,” the Daily Mail reported last December.

Last May, the Los Angeles Times revealed what drove Purdue Pharma’s Oxycontin campaign, and the false promise of pain relief for twice as long as generic substitutes, noting the company reaped “$31 billion in revenue” for its efforts.

Purdue Pharma is hardly an outlier. According to Mizuho Securities USA, approximately 80% of the global opioid supply is consumed in America, largely engendered by “about 300 million pain prescriptions written in 2015,” Mizuho senior analyst and pharma specialist Irina Koffler explains, noting that number precipitates a $24 billion annual market.

Driving that market is the reality that 99% of physicians prescribe opioids for longer than the three day period recommended by the CDC, the National Safety Council reveals. Nearly a quarter prescribe a month’s worth of opiates, despite evidence demonstrating 30-day use engenders brain changes visible on an MRI.

Doctors’ lack of awareness fuels much of this prescription abuse: 74% incorrectly believe opioids are the most effective ways to treat pain, despite evidence revealing over-the-counter meds like ibuprofen and acetaminophen offer the most effective pain relief.

Unsurprisingly, lawlessness is part of the mix. “After states began closing down so-called ‘pill mills,’ heroin and fentanyl began flooding the US to take the place of the prescription drugs that were no longer available,” explains National Center for Policy Analysis senior fellow Devon Herrick. In fact, between 2011 and 2015, deaths from heroin overdoses alone more than doubled.

The other side of the equation? “While millions of Americans suffer severe chronic pain, their voices are rarely heard in media coverage of the ‘opioid epidemic,’” Maia Szalavitz stated in a 2014 Washington Post column.

Szalavitz further notes the National Household Survey on Drug Use and Health, which spent years asking people about their misuse of pain medication, reveals 80% were not medically addicted pain patients. Rather, they were people who got opioids from friends, relatives, dealers, theft or online prescription forgery. Szalavitz insisted suppressing opioid use won’t address the overdose problem because addicts will simply switch back to street heroin while pain patients “will simply suffer.”

Yet it is apparent something must be done. “The calamity of the 1990s opioid revolution is not so much that it turned real pain patients into junkies — although that did happen,” writes Weekly Standard senior editor Christopher Caldwell. “The calamity is that a broad regulatory and cultural shift released a massive quantity of addictive drugs into the public at large. Once widely available, the supply ‘found’ people susceptible to addiction.”

For perspective, Caldwell cites other drug epidemics that afflicted the nation, noting the height of the ‘70s heroin epidemic produced annual death rates of 1.5 in 100,000 people, while the peak of the '80s crack epidemic produced a death rate of 2 in 100,000.

Opioids? “We’re up to about 12 per 100,000. In the state of New Hampshire we’re at about 30 per 100,000. In the state of West Virginia we’re at 40 per 100,000,” Caldwell reveals.

The U.S. Food and Drug Administration (FDA) is apparently getting the message. In an historic first, the agency is asking Ireland-based Endo Pharmaceuticals to stop marketing opioid pain medication Opana ER in the U.S. because of its potential for abuse. If they refuse to do so, the FDA will take steps to withdraw approval for a drug it insists has risks that outweigh its benefits.

Whether this is the beginning of a trend remains to be seen. As Lopez explains, opioid producers and suppliers have spent more than $880 million on lobbying to stop regulation and loosen drug standards. In addition, many civil libertarians decry efforts to criminalize drugs, likening it to the failure of Prohibition. They also point to thousands of people unnecessarily ensnared by mandatory minimum sentences — what Lopez describes as “the three-strikes laws that can get someone life for drugs, and the ridiculous probation and parole rules that can get someone thrown back into prison for little more than possession.”

But many civil libertarians who championed legalization of drugs per se are having second thoughts. “In a nutshell, I believe that people should be allowed to put themselves at risk if they want to,” writes Robert VerBruggen, who insisted the benefits of personal freedom would outweigh the costs of increased addiction. But like others, he now concedes that “it sure looks like loosening control of a drug made all hell break loose.”

National Review columnist David French agrees, insisting there are times “the hard experience of reality meets and overcomes the hopefulness of ideas” and that it’s time to kill the “bad idea” of drug legalization.

A sensible solution to the problem requires the answer to a critical question: How addictive are opiates? French insists they are “monstrous inventions that overpower the human will on a mass scale.” So much so that people with legitimate needs for controlling severe chronic pain should be sacrificed for the ostensible greater good of mitigating rampant addiction?

There are those that believe “making America great again,” as in restoring hope to many communities besieged by economic malaise, is a big part of the equation.

Perhaps. But as Robert Martin, director of substance abuse at Carolinas Medical Center, stated in a 2013 article about opiate addiction, many addicts come from the “best neighborhoods.”

Addressing America’s “cultural shift,” as in the decades-long moral malaise that has virtually enshrined a lack of personal reasonability, would be a far better place to start.

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