President Barack Obama wrote in the January issue of the Harvard Law Review, “As their [prescription opioids] use has increased, so has their misuse.” This is true, but blaming only overprescribing of opioids for the current opioid crisis demonstrates a lack of understanding about the complexity of the problem.
The putative argument President Obama and many others assert is that the opioid problem was created by an excess supply of painkillers flooding our communities. Excessive prescribing is part of the problem, but without demand, there would be no crisis.
“No longer ‘Mayberry’: A small Ohio city fights an epidemic of self-destruction,” reads the headline of a recent Washington Post article.
This article shows different layers to the opioid crisis that the president does not mention. For example, Teri Minney’s statement, “Now you can get heroin quicker in these communities than you can get a pizza. They’re delivering,” seems shocking, but it has nothing to do with opioid prescribing.
Minney’s observation that access to illicit drugs is as easy as calling for delivery of a pizza or an Uber car is corroborated in Sam Quinones, Dreamland: The True Tale of America’s Opiate Epidemic.
Washington Post Article May Hold the Missing Piece to the Opioid Crisis
Yet we are not making the advances we need to curb the opioid crisis, and the reason may be found within the Post article itself.
For example, look at this statement: “Federal officials have said they are committed to combating the epidemic but are focusing more narrowly on doctors, pharmacists and companies that continue to violate the law.” This suggests the Federal government is missing the real target. While some doctors, pharmacists, and companies may violate the law, and opioids may be overprescribed, the opioid epidemic has roots that go far deeper.
Obama’s focus is exclusively on the supply side, or treatment, of addiction. He writes, “My Administration has worked to combat this epidemic through targeted enforcement activities; funding new and unprecedented networks of law enforcement and public health partnerships to address the heroin threat; targeting heroin and prescription opioid traffickers and the illegal opioid supply chain; and thwarting doctor-shopping and disrupting so-called ‘pill mills.’ ”
President Obama and the Media Should Know the Problem Is Larger Than Overprescribing
What Obama and media sources are missing is an understanding of what drives drug abuse. Social and cultural diseases are major factors. The Post reports, “He’ll ask a young patient who has come in for treatment, ‘How did you get involved in this?’ and the answer will be, ‘My mother shot me up for my birthday when I was 14.’ ”
It is hard to see how overprescribing can lead to pushing heroin to your child. Heroin is not prescribed, and neither is cocaine. Heroin-related deaths have increased more than 250% in the past decade, while the number of prescriptions for opioids has declined about 18% from 2012 to 2015, according to Symphony Health Solutions. In fact, Pain News Network reports that “Overall opioid prescribing has been declining with about a 30% decline in the most commonly prescribed opioid–hydrocodone.”
People using heroin have an opioid use disorder. They should neither be treated as innocent victims, nor should they be stigmatized as low-lives who are unworthy of compassion. We should view them as human beings who have a life-threatening disease.
The common narrative presents people with addictions as victims of overprescribing by doctors whose actions are driven by Pharma. Perhaps this is a factor but such a narrow perspective limits potential solutions to other contributing factors.
As I said, social and cultural factors often drive the desire for opioids. Those who seek a “high” from drugs can find it in illicit substances that often are deadly. These illicit drugs are available all over the country with just one phone call or an Uber ride to the right neighborhood.
There probably have been too many opioids prescribed, but that doesn’t mean people in pain who need relief should be punished because of those who use drugs for non medical purposes. Taking opioids away from those who need them will not end the epidemic.
Ending Overprescribing Won’t Solve the Opioid Crisis
Solving the opioid crisis will require acknowledging the fact that people who suffer from poverty and hopelessness want relief from their psychic pain. And, unfortunately, the way in which they pursue relief is too often on the streets. If we focus on reducing the demand for drugs by improving socio-economic conditions in our communities, then we will be able to make sustainable advances toward ending the opioid crisis.
This is politically much more difficult than just limiting access to opioids for all. The long-term solution is to discover safer and more effective medications that can replace opioids. But, until that happens, there is only one strategy that can have a positive effect on the crisis without hurting people for whom opioids are the only way to manage their chronic pain. That is to address the reasons why drugs are used for non medical purposes in the first place.
Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.
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Copyright 2017, Lynn Webster, MD