Originally published by Morning Consuilt on August 31, 2018.
All levels of government are mobilizing in response to the opioid crisis and the sharp rise in fatal overdoses seen in recent years. The House recently passed a package of 53 bills aimed at addressing the problem, while the Senate has held numerous hearings and is considering its own bills as well. State governments are also dealing with the strain put on intensive care units and government finances, while local communities are left dealing with the emotional toll of so many overdoses and the fallout from a misguided crackdown on prescription pain medication.
The good news is that there appears to be enough political will to address the problem. That’s not the case for most issues plaguing the nation. The bad news is that the cause has been misdiagnosed, leading to solutions as likely to compound the matter as make it better.
The story told by media and politicians is mostly one of prescription drug abuse. In this telling, doctors are prescribing too many opioid pills and at dosages too high for patients suffering from severe or chronic pain, either because they are being duped by individuals looking to score drugs for recreational use, are naive to the risks of misused opioid medications, or are running “pill mills” for personal gain.
This narrative is appealing to politicians and the media because it allows for finger-pointing at easily identified villains: “Big Pharma is producing too many addictive pills! Doctors are putting greed before patient welfare!” The problem is that these stories are not supported by the evidence.
The focus on prescription opioids has led to frequent raids on doctor’s offices led by the Department of Justice, lawsuits against drug manufacturers from numerous states and pressure to lower dosages and shorten prescription lengths. As a result, patients with severe or chronic pain are suddenly losing access to medications that they have used for years, and in some cases the only ones that have ever worked.
Yet despite these draconian efforts, and the significant decline in opioid prescriptions that they have caused, deaths are still climbing.
That’s because it isn’t legitimate prescriptions that are driving the opioid epidemic. The synthetic opioid fentanyl is a far more common killer. Deaths from fentanyl have risen 847 percent since 2013, from 3,105 to an estimated 29,406 in 2017. Primarily manufactured overseas, fentanyl reaches users in the United States through illicit markets, not doctors’ offices. In 2017 alone, illegal street drugs like heroin and fentanyl accounted for more than 45,368 of opioid-related drug deaths.
It is important how Americans understand the narrative about opioids because policy solutions are shaped dependent on how the issue is internalized. Attempting to solve the wrong problem can lead to disastrous results.
For instance, Dr. Thomas Kline, a North Carolina physician, has a running list of suicides known to be related to loss of pain medications. The list is composed of people, many of them military veterans, who were successfully being treated until misguided government recommendations and aggressive raids on medical facilities scared their practitioners away from evidence-based pain treatment.
Sadly, bad policies are not just coming from the top but are proliferating across the union. Oregon regulators are drafting a plan for a “forced taper” for sufferers of chronic pain and fibromyalgia on Medicaid, entirely replacing effective medication with alternatives like “mindfulness” and “pain acceptance.” New York passed a fee on opioid manufacturers, which will be passed to consumers, and other states have either tried or are considering similar measures.
The White House Council of Economic Advisers estimated the economic burden of the opioid crisis to have been $504 billion in 2015. This includes costs associated with health care, criminal justice and lost productivity, which don’t even begin to measure the collateral damage of cracking down on prescription medications.
That’s why we started the initiative Taxpayers Against Illicit Opioids to expose the Mexican cartels and Chinese manufacturers that are flooding the U.S. market with deadly fentanyl. If there’s any hope of sparing taxpayers from the burden of a drawn-out campaign, politicians need to get it right. And that requires looking past the easily vilified and identifying the correct problem.
