Addressing the Opioid Epidemic, Part 1
The Misplaced Priorities of the Trump Administration
The U.S. is currently being blighted by the deadliest opioid epidemic in its history. With more than 63,600 overdose deaths in 2016, and an expected higher number in 2017, the situation is only getting worse. It is now officially a public health emergency.
This crisis is attributed firstly to the over prescription of opioid painkillers, which, in turn, prove to be highly addictive. The increased dependence and tolerance for opioids then led to the acquisition of stronger drugs such as heroin, and more recently, the highly potent and lethal drug, fentanyl.
As the country continues grappling with this issue, the Trump administration, in March 2018, proposed its plan to tackle the ongoing epidemic.
President Trump emphasized stricter penalties for drug dealers and traffickers, ranging from mandatory minimum sentences for opioid trafficking, to going as far as proposing the death penalty.
There was also mention of trying to reduce the number of prescribed opioid painkillers, increasing access to medication-assisted treatment (MAT) for opioid addiction, and of advertising campaigns discouraging opioid use.
Meanwhile, the U.S. Congress has earmarked funding of $3.3 billion in its March 2018 Omnibus Spending bill to combat the opioid crisis.
Looking at the proposals of this current administration, there is a definite prioritization of punitive measures, as opposed to a clear plan focusing on increasing accessibility of treatment. Much of the President’s address focused on being “tough on drug dealers” and reiterating the importance of his proposed U.S.-Mexico border wall.
Meanwhile, little detail was provided into the actual measures that would be taken by the government to treat the affected population. This approach is an erroneous one that would be ineffective in solving what is a national crisis. There needs to be a shift in focus towards the more pertinent areas that the administration mentioned (in passing) in its proposal: those of increasing access to treatments for opioid addiction, implementing preventative measures, and reducing the prescription of such addictive opioids.
The Inefficacy of Punitive Measures
With respect to emphasizing tough punitive measures, the premise is that tougher enforcement and penalties will discourage trafficking, making the drugs more expensive and harder to obtain, ultimately resulting in lowered consumption.
However, this approach, one which has been attempted before, would not prove to be successful in achieving its intended goal.
Reviews of empirical research have assessed increases in enforcement in relation to drug costs and consumption, and found that tougher punitive measures have had little to no effect on both drug prices and consumption (Pollack & Reuter, 2014).
In fact, incarcerating drug offenders has been stymied by the ‘replacement effect,’ whereby the drug market replaces imprisoned drug dealers with new recruits, or by ramping up sales of drugs by drug dealers still selling on the market (Piehl et al., 1999).
Secondly, the distinction between traffickers and users is not so straightforward. Many incarcerated traffickers have actually been abusers of opioids themselves. Almost 30 percent of prisoners involved in the drug trade did so to ultimately acquire enough money to obtain drugs for themselves (Mumola et al., 2004).
U.S. prisons are ridden with victims of opioid abuse, and this tougher line of enforcement would merely punish many of the same victims of this crisis.
As for the highlighted importance of the U.S.-Mexico border wall, it must be pointed out that much of the smuggled heroin does, in fact, come from Mexico, with fentanyl manufactured predominantly in China and also entering the country through Mexico.
However, the bulk of these drugs enter the U.S. through ports of entry, such as airports, often through mail packaging (DEA, 2016). Therefore, this proposed border wall would not have a marked effect in quelling the infiltration of drugs into the country.
Treating the actual victims and targeting the demand for, rather than the supply of opioids should be at the forefront of tackling this epidemic.
Increasing Availability of Medication-Assisted Treatment is Key
The emphasis should be on the ‘go-to’ solution for opioid dependence and overdoses: that of medication-assisted treatment (MAT).
Naloxone, methadone, and buprenorphine have all been well-established as effective medications to reverse opioid overdoses, substantially reducing mortality rates in people with opioid dependence (Sordo et al., 2017).
These medications have also been shown to treat opioid addiction by suppressing illicit use of opioids and facilitating greater retention of users in treatment for opioid dependence.
Naloxone, for instance, is an opioid-receptor antagonist, blocking the interaction with, and hence, physiological effects of opioids (Mattick et al., 2008).
Increasing the availability of these medications is an integral part to combating the opioid epidemic, something which the Trump administration, to its credit, did mention in the address to the nation.
They also mentioned their proposal of increasing access of naloxone to first responders, as well as to prison operators, so as to connect prisoners screened for opioid abuse to requisite naloxone treatment. The latter step could be potentially groundbreaking as a lifesaving intervention, particularly since, as previously mentioned, many incarcerated individuals were abusers of opioids, themselves.
The issue is the sheer cost of medications such as naloxone, and this allocation of funding is where the greater facilitation of MAT in the U.S. becomes difficult.
Moreover, given the sheer potency and exponentially growing consumption of fentanyl, which has also been found in traces of distributed heroin, a much higher dose of naloxone would be required for any therapeutic effect.
The author anticipates earning a medical degree in 2022 from Stony Brook University School of Medicine.
Mani,, R. (2018). Addressing the Opioid Epidemic, Part 1. Psych Central. Retrieved on April 22, 2018, from https://pro.psychcentral.com/addressing-the-opioid-epidemic-part-1/