Solving the Opioid "Crisis"
Hint: It's already been done once
Since President Nixon declared the ‘war on drugs’ 1971, the United States has spent billions of dollars trying to battle drug abuse. The primary methods involve controlling and restricting access to opioids (think pain medicine) and their relatives, along with a criminal justice approach that includes possible jail time.
In 2016, around 64,000 people died of overdoses from drugs of any type. That’s about one every 8 minutes and a large increase from the year before. Responsibly used medicines did not show up in these totals. The death count continues to rise and total the impact to the U.S. economy has been estimated at about a million dollars a minute.
The war is extremely expensive, but for nearly 50 years the results have not improved. The former presidents of Brazil, Columbia, and Mexico referred to the global war on drugs as an unmitigated disaster.
Dealing with the drug problem is a lot like squeezing a balloon. Clamping down in one area often results in the expansion of another. For example, when the U.S. tightened the rules on prescription hydrocodone in 2014 (think Lortab® , Vicodin®, and many more), there was an almost immediate expansion in the use of illegal heroin and fentanyl.
In the 1920’s, the U.S. tightly restricted alcohol. As the regular supply channels were squeezed, organized crime expanded and bootleggers prospered. In some cases, contaminated product caused injuries and deaths. Sound familiar? Responsible users were harmed as a result of someone else’s crusade. The short version is that prohibition didn’t work for alcohol and it isn’t working for opioids.
There are limited alternatives to opioids. Even so, the U.S. Drug Enforcement Agency has been constantly cutting the total amount of pain medicine that legal drug companies are allowed to produce. In other words, it’s more prohibition and there have been shortages.
This makes drug bootleggers very happy. Because when you’re hurting and can’t find legitimate help, you may look in sketchy places to ease the suffering. Without good medical guidance, folks are now at greater risk of being arrested or becoming addicted.
It’s worth noting that dependence and addition are not the same. For example, huge numbers of people depend on insulin, but they are not addicted.
Insulin is certainly a vital agent, yet robberies to get it are rare. This is primarily because the product is better managed. Use opioid tactics (prohibition) to restrict, or simply price it out of range, and black market activity will find a home with insulin. It’s already happening with related supplies such as glucose testing strips.
With any medicine, tolerance may develop. In simplest terms, that means, over time, it may take more medicine to get the same results. It creates added reliance on the medication but it’s not the same as the insatiable cravings and “do anything to get” actions of an addict.
Folks take medicine and use devices because we can’t fix their problem. They’d rather be cured than chained to anything. Until that day arrives, they depend on these products.
Alternatives are scarce. The commonly suggested ones, such as NSAIDs (think ibuprofen, naproxen), aren’t always good replacements. Heart attacks, strokes, stomach ulcers, kidney problems, and increased blood pressure can eventually result from using them. The FDA recently issued stronger warnings for use of non-aspirin NSAIDs.
Could we be doing more harm by trying to force people away from well managed opioids? A solution to the 'crisis' is available.
Now let’s look at Portugal.
Portugal’s 'war on drugs' wasn’t getting good results, either. They spent a lot of money physically arresting people, not counting jail and court expenses. After years of the conventional methods, they still had one of Europe’s highest overdose death rates. Sound familiar?
So, in 2001, Portuguese officials took a different approach. They reasoned that the root of drug abuse was related to people seeking relief from suffering. In their new strategy, the same drugs remained illegal, but merely using them was treated as a public health problem, not a criminal one.
People were offered help instead of punishment. Depending on the situation, there might be a fine, an evaluation for addiction symptoms, and referrals to various medical treatments – some free, but no jail time for simply using. Soon after the program began, there was a huge decrease in overdose deaths. People apparently felt safer getting help.
Today, Portugal’s results remain impressive. Overdose deaths have decreased to about 30 per year. If the United States were as successful as Portugal, we could average less than 1,000 deaths per year (versus the 64,000 and rising, that we have now).
Clearly, the current U.S. tactics aren’t working nearly as well as Portugal’s approach.
The potential dollar savings are huge, too. Reinvesting those dollars into cures for lupus, cancer, and other painful conditions would have multiple paybacks including reducing the need for opioids in the first place. The associated problems dissolve away.
Might the U.S. begin helping itself by simply adopting Portugal’s existing, working, approach as our national strategy? In short, could we copy and paste a successful program?
The Portuguese didn’t just keep squeezing their balloon. They let the air out of it.