America’s opioid epidemic

Fentanyl, a synthetic opioid, is one of the worst offenders in the current public health crisis, in part because it is so much stronger than heroin. The picture compares a lethal dose of heroin with a lethal dose of fentanyl. (Source: Business Insider / New Hampshire State Police Forensic Lab)

On October 26, President Trump declared America’s opioid epidemic a “public health emergency.” Despite this, the administration failed to release the additional funding necessary to combat the crisis. Instead, they proposed a “really tough, really big, really great” advertising campaign aimed at encouraging teenagers to simply “not take drugs.” In Trump’s own words, “it’s really, really easy not to take them.”

The Trump administration made short mention of viable solutions and focused solely on the supply side of the crisis.

The suggested solutions included: blocking shipments of fentanyl from China, training doctors in safe practices when prescribing pain medication, and developing non-addictive painkillers. While these solutions may help to curb the epidemic’s seemingly exponential growth, they do nothing to help those currently battling opioid addiction. The demand side of the equation must be accounted for. To effectively combat the epidemic, the administration must issue directives that not only prevent the emergence of news users but also rehabilitate those currently suffering from addiction.

By failing to declare the opioid epidemic a “national emergency”—a directive that would have immediately allocated new funds to address the issue—the administration has dramatically downplayed the severity of the crisis and has failed not only those suffering from addiction, but the nation as a whole.

 

A Clearer Picture:

The opioid epidemic is the deadliest drug crisis in American history and is responsible for claiming over 140 lives each day according to the Center for Disease Control. Although the crisis is most severe in the Midwest, Appalachia, and New England, the reach of heroin, fentanyl, and other synthetic opioids has spread across the country in recent years. In 2016 alone opioids were responsible for claiming almost 64,000 lives and are currently the leading cause of death for Americans under 50 years old.

 

What are Opioids?

Opioids are a class of drugs that interact with opioid receptors in the brain to effectively block the transmission of pain signals. Opium was the first drug of its kind and spawned the creation of more potent, synthetic varieties such as Vicodin, Percocet, OxyContin, heroin, and most recently, fentanyl.

Infographic courtesy of The New York Times

 

How did this happen?

The current crisis began in the 1990s with the over prescription of pain medications such as OxyContin and Vicodin. The increased availability and lax laws regulating the Rx trade allowed “pill mills” to pop up across the country and prescription medications to flood the market.

At the same time, the prices for synthetic opioids plummeted, making heroin and counterfeit pharmaceuticals available for a lower cost than their prescription counterparts. This low-cost, high-potency solution was an attractive alternative for many whose prescription usage had escalated to addiction. Heroin, fentanyl, and other synthetic opioids thus gained a stronghold across the U.S.

 

What can be done?

While there is no silver bullet, there are a number of viable solutions that should be implemented to combat the crisis more effectively.

Firstly, the administration should declare the opioid crisis a “national emergency” and release the funds necessary to deal with the epidemic at a foundational level. These funds can be employed to open additional treatment centers and clinics, support medical research, and increase the supply and availability of life-saving antidotes, such as Narcan and Suboxone.

Secondly, the government should change the way it deals with drug possession charges and addiction treatment within prisons. Current drug policies are punitive in nature and place emphasis on retribution over rehabilitation. The risks associated with facing criminal charges inhibit many users from seeking treatment. For those already in prison, there is a lack of effective rehabilitation options available. Those who struggle with opioid addictions are treated as criminals rather than individuals in need of medical intervention. The government should reduce the mandatory sentences associated with drug possession and implement evidence-based treatment programs within prisons in order to effectively reduce addiction rates.

Thirdly, in the absence of federal action, communities should begin to employ harm reduction strategies such as syringe exchange programs (SEP) and law enforcement assisted diversion (LEAD). SEPs offer clean needles to users in order to prevent the spread of HIV and other infectious diseases. LEAD strategies give law enforcement the ability to use discretion to divert users away from prisons and to case management facilities that assist them in finding rehabilitation programs, employment support, and housing. Despite the proven effects of harm reduction strategies, communities have been slow to adopt these methods on the grounds that they “condone and encourage illicit drug use.” A recent report by The Vera Institute of Justice highlights the empirical evidence supporting these policies and stresses the crucial need for their adoption.

While these solutions are by no means prescriptive, they offer a more feasible and empathetic approach to dealing with the current opioid epidemic.


Rebecca Castaldo is a first-year Master of Public Administration candidate at The London School of Economics and Political Science (LSE). She holds a BA in History and Global Studies from Lehigh University. Prior to attending LSE, she worked at The New Yorker magazine for two years. 

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