Federal Gov’t Inadequately Addresses Opioid Crisis

Early in September, the Centers for Disease Control and Prevention (CDC) published a staggering report finding that, from March 2016 to March 2017, over 65,000 Americans died of drug overdoses, a number 18.8 percent higher than the previous 12-month ending period. In 2016, Ulster County alone saw 195 opioid overdoses resulting in death or hospitalization. According to an analysis of the report by The New York Times, the drug overdose epidemic is “killing people at a faster rate than the H.I.V. epidemic at its peak,” with many of those overdose deaths the consequence of opioid abuse. The class of drug known as opioids is defined by the National Institute on Drug Abuse (NIDA) to include “heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone, hydrocodone, codeine, morphine, and others.” NIDA also determined that prescription opioid use increases the risk of future heroin abuse.

On Oct. 26, Pres. Donald Trump ordered the U.S. Department of Health and Human Services (HHS) to declare the opioid crisis a “public health emergency.” Under the Public Health Service Act, the declaration of a public health emergency by the Secretary of Health and Human Services grants more autonomy to HHS in its operations. Among other things, HHS is allowed to waive certain burdensome government healthcare requirements, access the Public Health Emergency Fund, and deploy medical personnel to underserved communities. Such a declaration also allows people suffering from opioid addiction to obtain dislocated worker grants through the U.S. Department of Labor.

We at The New Paltz Oracle believe that more needs to be done beyond the simple declaration of a public health emergency. A public health emergency only lasts for 90 days after its declaration, at which point the Secretary must renew it; this is why, typically, public health emergencies are issued for short-term, more localized crises like infectious outbreaks, not widespread drug abuse. A national state of emergency, however, would do more to deal with the crisis. If declared by Pres. Trump, money could be allocated from the federal disaster relief fund to combat opioid addiction—this is in addition to many of the benefits also granted by the declaration of a public health emergency. That money could then be used to, for example, provide law enforcement agencies with ample amounts of naloxone, a medication used to stop the effects of an opioid overdose. Additionally, a national state of emergency is renewed annually instead of every 90 days, which is more appropriate for a large-scale public health issue.

Beyond that, one major solution to the crisis comes in the form of comprehensive legislation.

Last year, then-Pres. Obama signed the Comprehensive Addiction and Recovery Act, which authorized Congress to distribute over $181 million annually for efforts to fight opioid addiction. This past February, Congressman Bill Foster (D-IL) introduced into the House of Representatives the Opioid Abuse Prevention and Treatment Act. Under this act, HHS would award grants to states in order to “develop a standardized peer review process and methodology to review and evaluate prescribing and pharmacy dispensing patterns.” Such a process would accurately identify those doctors that are overprescribing opioids to their patients. The act would also trigger an FDA review of naloxone in an attempt to make it available as an over-the-counter drug, and encourage states and municipalities to set up drug disposal programs for community members to get rid of their leftover narcotics.

Efforts taken against prescription opioid abuse, however, must not be made at the expense of patients who legitimately need them. In October 2016, the U.S. Drug Enforcement Administration (DEA) reduced the number of opioids manufactured in this country by 25 percent, under the authority of the Controlled Substances Act; this year, the DEA proposed another 20-percent decrease. In March of 2017, the CDC published guidelines for doctors prescribing opioid treatments. Though these all seem like logical steps towards reducing opioid abuse, they treat every opioid user as equally susceptible to addiction, and can ultimately restrict access for adults with chronic pain conditions—over 100 million in America, according to a 2011 report by the National Academy of Medicine.

Changes must also be made in the way certain individuals are treated for opioid addiction. Though there is a stigma attached to it, the efficacy of medication-assisted treatment is scientifically proven. In medication-assisted treatment, opioids like methadone and naltrexone are administered in a medical setting in doses large enough to sate the patient’s opioid withdrawals, but small enough so as not to produce the euphoric high. Unfortunately, this form of treatment is highly inaccessible due to prescription ceilings implemented by HHS for buprenorphine-naloxone, an opioid commonly known as Suboxone and used in medication-assisted treatment. Another form of treatment, though more taboo than medication-assisted methods, is prescription heroin. Prescription heroin is medical-grade diacetylmorphine, administered with clinical supervision so as to be able to respond in the event of an overdose. The logic is that, by providing a safe location to inject heroin, people who would shoot heroin regardless will be less likely to overdose on street heroin often laced with other drugs. It, too, has shown positive results; a 2015 study published in The British Journal of Psychiatry found that prescription heroin is “an effective way of treating heroin dependence refractory to standard treatment.”

This is not to say that abstinence-based rehabilitation is ineffective, but rather that it’s not universally effective. To truly treat opioid addiction as effectively as possible, we must remain open to alternative methods provided they meet a scientific standard. We must also consider preventative measures, such as better, more widespread education on the dangers of opioids and alternative treatments for pain management such as medical marijuana.

We at The New Paltz Oracle believe the scale of this epidemic merits a far greater response from the federal government. There has been much talk of ending this epidemic, but we must address the problem with more nuance. A “one size fits all” series of efforts will only serve to punish Americans who need painkillers to physically function, as well as limit the treatment options for people who are addicted. Because what good is throwing money at a problem if it’s buying so few solutions?