Why Can’t We Learn from Our Opioid Mistakes?

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Demonstration in Wash DC 2011. Photo by Elvert Barnes via Flickr

In July 2015, a high school athlete overdosed on opioid prescription painkillers, after a long drawn-out attempt to get off them.  He was one of tens of thousands killed by opioid addiction in this country yearly.  Yet policymakers never fully consider the contributing factors to this problem when they pass legislation aimed at addressing what many people are now calling a health crisis.

And we seem unable to learn from our mistakes.

For instance, the US government aimed to reduce the supply of heroin by spraying coca fields (which produce the main ingredient for crack and cocaine) in Colombia. But federal policymakers failed to do anything about the country’s poppy fields (the main ingredient for heroin.

Seemingly as a result, deaths by heroin overdoses between 2002 and 2013 rose by 286%, according to the CDC.

Policymakers at all levels have repeatedly failed to consider why their policies don’t succeed. Worse, they overlook the unintended consequences of their actions, which can create undue suffering to users.

The lesson is certainly being ignored by the Trump Administration, which appears ready to continue Washington’s support for  “Plan Colombia”.

But these types of failures aren’t limited to the federal government.

In 2010-2011,  Florida regulated opioid painkillers through prescription drug monitoring programs (PDMPs).  The result was a 28% decline in painkiller deaths, but this was undermined by a 122% increase in deaths from heroin overdose.

Florida policy makers fell into the same trap the federal policymakers did: They did not fully consider their actions and only acted on part of an overall problem.

Along with these government failures, healthcare providers are also guilty of not fully considering the consequences of their treatments.

Consider, for example, the way methadone treatments are currently used.  The treatments are a method of easing the withdrawal of patients by using methadone (another opioid).  But the drug, while less harmful to the body and effective in preventing withdrawal, is just as addictive as heroin and its withdrawal symptoms are just as brutal.

This more socially acceptable addiction can make people emotionally dependent, as they will believe that they are not strong enough to fully phase off of methadone.  It becomes their only ticket for a “normal” life.

Another issue plaguing the healthcare system is chronic over-prescription.  Doctors have been prescribing opioid painkillers and other medications to an extreme degree over the past 25 years, leading to a ballooning number of painkiller related deaths and addictions.   Now that the DEA is trying to regulate this overprescribing, many of the addicted will likely follow suit with the Florida example.

Law enforcement in the United States is the most vivid example of poorly thought-out responses to opioid use.  The current favorite method is mass incarceration, with a heroin possession minimum charge in the US on average having a one year sentence. The offender is taken away from the outside world to sit in a jail cell as a criminal for what has become a medical issue.

According to the National Criminal Justice Treatment Practices Survey, convicts are four times more likely than the general public to have a substance abuse problem, and only 10% of them receive treatment.

There is a racial aspect to this epidemic as well.  The “treatments-over-incarceration” trend only really began when the face of drug abuse started to include young suburban whites. This means that the lack of proper policy regarding opioid addictions was partially racial, and became part of the reason for the current disproportionate incarceration of minorities.

There’s no good solution to this epidemic that can be offered in an Op Ed column, but attention to cost and availability provides a good framework. When forming policies, such as Plan Colombia or the Florida monitoring programs, these two dynamics are typically ignored.

This suggests that the government will support the same types of treatments discussed earlier, without an effort to fine-tune them so they produce the results everyone wants.

The administration’s war-on-drugs vocabulary hasn’t changed from the mindset that created mass incarceration.  To top it off, the proposals so far on the table to eliminate the Affordable Care Act would make it difficult for many sufferers to receive proper rehabilitation treatment.

Jessica Fuentes-Diaz

Instead, upgrading our current policies would better address the nation’s substance abuse issues; for example, working on PDMPs could save many lives.

These programs are very effective in dropping the rate of painkiller abuse, as shown in the Florida example, but fail to stop people from switching over to more dangerous drugs.  The programs should be augmented with a net that flags individual prescription information for those who are potentially addicted, and those found at risk due to doctor over-prescription or other circumstances should be placed under a monitoring program.

This monitoring could be accomplished through drug tests or community support, and if people are found to have continuing substance-abuse issues they can be brought under the wing of health care officials.  This increases the social and legal cost of any drugs.

James McAdoo II

Similar attention to detail should be placed on other policies and programs with no expense spared.  The people suffering from this spreading health crisis deserve our full attention.

Considering how much we spend on incarceration, we can afford to give a little help.

James Alexander McAdoo II and Jessica Fuentes-Diaz are students at George Mason University. James studies Conflict Analysis & Resolution, and Jessica’s area of concentration is global affairs.  They welcome comments from readers.

 

4 thoughts on “Why Can’t We Learn from Our Opioid Mistakes?

  1. James & Jessica,

    As a cofounder of LEAP- law enforcement action partnership, I represent them in Congress as their lobbyist. I’ve also become very familiar with the Swiss approach to handling heroin issues. This from personal visits in 01, 08 and 2016. Being fluent in French and German facilitated a better understanding.

    The Swiss have arguably the most effective, pro life approach in the world, now copied in six European countries

    Your article is spot on in every respect as the US uses mid 20th century thoughts for a very 21st-century problem.

  2. It’s sad to see what is an otherwise spot-on piece about the failure of US drug policy sullied by a terrible proposal, and a stunning limited view of medication assisted treatment. While the idea of using mass surveillance of patients to single out people who are “potentially addicted” for additional (and presumably coercive) “monitoring” chills me to the bone, even more troubling is the lengths the authors go to reinforce the stigma against methadone. The oft-repeated (and patently false) assertion that methadone maintenance is the ‘equivalent of trading one addiction for another’ leads to deadly consequences in cities like Philadelphia, where people are dropping like flies from $5 bags of fentynal. I’ve seen too many people refuse to go on MMT – and subject themselves to multiple failed attempts at abstinence rehab –
    because of this kind of thinking. While the authors are correct in pointing out that methadone carries a similar withdrawal as heroin (it’s actually milder, but endures much longer) by describing methadone patients as “addicted” they demonstrate a lack of insight into the meaning of that term. Addiction in a psychological affliction characterized by obsessive-compulsive behavior. Dependency is a physiological response to a substance. It is certainly possible to be addicted to methadone, but it’s unlikely. Methadone lacks many of the qualities that make heroin a far more addictive substance. As a long acting, orally administered opioid analgesic, it lacks the “rush” associated with IV heroin. It’s long half life means withdrawal is abated for 24-36 hours – as opposed to heroin’s 6-8 — so the compulsion around use is limited. What’s more, the factors that drive addiction go far beyond the physiological effects of a substance. There’s the ‘hustle’ the ‘copping’ – preparing a shot – the entire lifestyle of addiction is a component of the addictive behavior. By giving addicts the ability to stabilize and, if properly supported, to remove themselves from this lifestyle, methadone is as close to a silver bullet for heroin addiction we will ever get. (Buprenorphine is a close second). While it’s encouraging to see more people exploring the terrible track record of America’s War on Drugs, it won’t do much good if it comes at the expense of credible information (or civil liberties).
    – Christopher Moraff, Contributing Writer, The Crime Report

    • Hi Christopher,

      Thank you for reading our article! We appreciate your comments and will try to clarify ourselves here, and apologize that we weren’t able to respond sooner as we had final exams in our undergraduate classes.
      We think there’s a misunderstanding of the term monitoring, and that we may not have been clear enough: we simply mean occasional drug tests for people, not an overly intrusive surveillance by law enforcement or other entities. From what we understand, the PDMPs already have data on doctor prescriptions and we want this data used to help the people who are at risk.
      As for methadone, we aren’t suggesting an end to the treatments nor are we saying it should be illegal. The main point of this article is to reveal deficiencies in the current way opioid policies exist and are implemented, and we want this analysis to help improve the systems rather than eliminate them.
      Methadone treatments tend to be touted as the “silver bullet” for opioid addiction, but this status comes with psychological drawbacks. People come to believe that without the drug, there’s no possible way for them to become a normal functioning person. This leads to that same type of obsessive behavior that comes from the lifestyle, but now it’s the only thing keeping you strong enough to be normal. Without recognizing these issues, nothing can be done to improve the system.

      Thanks again,
      James McAdoo & Jessica Fuentes-Diaz

  3. James and Jessica,

    While I may be biased, considering that I am one of your instructors, I am very impressed by your article, which was written during your undergraduate studies. More importantly, I am heartened by your response to harsh criticism. I am confident that you will continue to learn and refine your arguments on America’s drug policy, which will be strengthened by informed debate.

    Best,

    Dr. Kim Mehlman-Orozco

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