By Joe Chivers
It is no exaggeration to state that the Opioid epidemic that is currently ravaging the United States is the largest public health threat to the nation today. Indeed, it is hard to underestimate the true scale of its devastation. In 2016 alone, 64,000 Americans died from overdoses. In 1999, that number sat at just 4000. Over the next decade, it is feared that half a million people could die such unnecessary and tragic deaths. The epidemic has caused such an impact that the average life expectancy for both men and women has dropped, down from 78.7 to 78.6 years. Men are disproportionately affected, but women too, are dying in their thousands. As well as the human cost, the crisis is also proving costly in financial terms, costing the United States around $504 billion in 2015.
If you have been following news of the crisis at all, you cannot have failed to notice that by and large, the drugs at the heart of it are not heroin, but prescription painkillers. In the nation at the head of the drug war, the villain at the heart of the piece is not some great cartel, but a broken healthcare system. This is not to suggest that most doctors and nurses are personally at fault, not in any way. There is, however a culture that has developed over time where strong opioids are being prescribed far too readily. This will not be a problem that will have an easy solution in the US. It is all too apparent, too, that it is the nation at the head of the drug war which is experiencing this crisis. However, we are not going to focus on that. It would be disrespectful in the extreme to make merry with the news that thousands upon thousands are suffering from addictions and dying early. Instead, we’re going to focus on the attempts that are being made to solve the crisis, and potential future solutions.
The root of the problem goes back to the 1990s. It was estimated that at this point, a third of Americans suffered from some kind of chronic pain. While a lifestyle change may have helped, the federal government and various drug companies began to push strong opioids as a solution. This led to overprescription, with many people continuing to use the drugs even once their condition abated. Over the 20 year period from 1991-2011, the amount of opioid prescriptions tripled. The strength of the drugs also increased, with one-in-three drug users being prescribed drugs stronger than morphine in 2012. Drugs are also cheaper than therapy, so are particularly favored by the poorer segments of society for whom insurance companies will not pay for the more expensive option. In other countries with single-payer healthcare, the rates of addiction are far lower.
Recently, some people have been trying to take action against drug companies, suing them for misleading the public. Governments, too, are suing drug companies for the expense incurred from the epidemic. The government has pushed prescription drug monitoring programs (PDMPs) as a potential aid in ending the crisis. These programs allow pharmacists and doctors to access patient histories, identifying potential drug-seeking behavior. It is known that those who take the drugs for more than three months are more likely to become addicted. However, many doctors are apparently unaware of the programs, or, if they are aware of them, do not use them. However, in Florida, it was noted that high-risk prescriptions dropped moderately. Other attempts to prevent addiction include so called “pill mill laws,” which prosecute doctors who are overprescribing drugs to their patients.
Other areas are beginning harm reduction approaches. For example, Naloxone (or Narcan), a drug that can reverse the effects of an overdose, has been issued to first responders in some areas. In others, Naloxone has been distributed in kits across areas experiencing spikes in overdoses, which have been shown to provide a substantial reduction in deaths. Another possible form of harm reduction, which are gaining more ground in countries around the world, are safe injection sites. These are hygienic and supervised sites that can help prevent the spread of bloodborne diseases and the risk of death from overdoses. The first safe injection site in North America opened in Vancouver in 2003, but federal law forbids such facilities in the United States, according to the Justice Department. This has not stopped a number of cities from planning such facilities, including San Francisco and New York. Despite the possible ramifications, one social services agency in the United States has been running one of these facilities in secret, with no deaths occurring there in three years from 2014-2017. Four overdoses did take place, but all were reversed.
While several possible means of preventing others from becoming addicted has been discussed, it is also important to talk about helping those who are already addicted. The United States, and the western world as a whole, has a massively slanted view towards addiction and those who are addicted. Due to the national inculturation of capitalism and a strong seam of the protestant work ethic, those who cannot work are seen as lazy scroungers. Those who are effectively disabled by their addiction garner little sympathy, even from those who would call themselves liberal. They are seen as lacking in moral fiber and self-discipline, and are believed to have brought their problem upon themselves. It is also key to note that there is something of a racial bias towards addiction in the US. Heroin addiction was once associated more with black jazz musicians than white suburbanites, leading to even greater condemnation. Even today, media coverage paints a far more sympathetic picture of white addicts than non-white ones. The nation needs to have a discussion on addiction. To recognize it not as a problem of moral fiber, but as a disease. As we have previously discussed in relation to Portugal, these national conversations tend to spring up when things are at their worst. When everyone can point to someone they know as suffering from this ailment, sympathy grows. This is the time to be having this conversation. The grand mental symbol that is the addict lying in the gutter with a syringe in their arm needs to be replaced with one of your friend who is hooked on Oxycontin, your mother who got addicted after being treated for her cancer, or your brother who died from a mixture of Xanax and Percocet.
There are means to help those who are addicted. Drugs which can be used to help taper down opioid addicts have been around for a long time now. The most well-known example is methadone. This drug works by binding to the opioid receptors in the brain, reducing withdrawal symptoms. It is here that we meet with another peculiar problem facing the United States. The drug is not available everywhere, and the nearest methadone clinic can be hundreds of miles away, as was the case for Rebecca Schmaltz of North Dakota. Each dose must be collected from a clinic, and bulk supplies cannot be given. This, in a nation that is happy to hand out fistfuls of painkillers. The solution is to make methadone widespread, subsidised, and delivered to those unable to make it to the clinic. This is not as radical a solution as it may sound. Portugal, once again, shows us the way. It too had a problem of not having nearly enough treatment centers, so it built more.
It is not only methadone that is a potential cure for the epidemic. Another drug is available, called buprenorphine, or Subutex. This can be dispensed at doctors’ offices, unlike methadone. However, here, we meet another distinctly American problem. While this solution previously worked in France, slashing overdose deaths by 79 percent, France has universal healthcare. In the United States, the expense of treatment is not paid for by the taxes, but by insurance companies. Insurance companies who want to keep costs down, and opioid treatment is far from cheap. As such, insurers sometimes flat out refuse to provide treatment. That leaves those who are addicted, often from poorer economic backgrounds, having to pay for treatment themselves. If they cannot pay, then they must remain addicted or go through the hell that is cold turkey withdrawal.
The epidemic is not insoluble. The solutions are here, in front of our very noses. Other nations have gone through similar crises and produced remarkably effective solutions. In both Portugal and France, public health issues of addiction have been extinguished thanks to strong healthcare systems and governments civic-minded enough to make these changes. Healthcare professionals must be discouraged from prescribing addictive drugs so readily, and prosecuted if necessary. Those who are already addicted must be given compassion and effective medical help. However, both parts of this will require a federal government willing to both take the issue seriously and to provide the public funds in order to do this. If the federal government does not change its stance soon, then nobody can say just how long this epidemic will last.
Joe is a print and online journalist, based in Europe, who specializes in writing on war and social issues.