Opioid addiction is a disease, not a choice; Congress, White House should act accordingly
Author: Chase Kohne - October 30, 2017 - Updated: October 30, 2017
Nearly 3,000 Americans died in the Sept. 11 attacks. The opioid overdose emergency now kills the same number of Americans every three weeks. The overdose death toll has grown 532 percent since 2002, overtaking car crashes as a leading cause of death; last year, 528 Coloradans died due to opioid overdose in another record year for drug deaths. By now, most Americans know someone who has struggled with addiction and many have lost someone they love.
While President Donald Trump symbolically declared the opioid crisis a public health emergency again last week, the White House has taken no concrete steps to drive down its mounting death toll. The current administration still falsely believes it can solve this crisis by arresting and imprisoning people battling addiction — an approach that’s as costly and ineffective as it is cruel.
I witnessed the opioid epidemic at its source when I deployed to Afghanistan. In Afghanistan, which grows more than 90 percent of the world’s illicit opium, the drug is so ingrained in daily life that bricks of raw opium are a common sight in homes. Many Afghans self-medicate with raw opium, even giving it to their very young children. They usually don’t understand that they are addicted.
It’s not much more difficult to obtain opioids in the United States: recent trends in pain control, spurred by overly aggressive pharmaceutical marketing, drove doctors to prescribe these drugs in staggering amounts: By 2010, Americans comprised five percent of the world’s population while consuming 99 percent of its hydrocodone (Vicodin), 80 percent of its oxycodone (OxyContin), and 65 percent of its hydromorphone (Dilaudid).
As the amount of prescription opioids sold to pharmacies and physicians quadrupled, so did the number of prescription opioid overdose deaths. Addiction frequently begins with careless pain control: tolerance buildup forces patients and doctors alike to ever higher doses for the desired effect. Overuse leads to dependency and eventually to routine abuse. Countless Americans became addicted to opioids not because they made bad decisions but because the doctors they trusted told them to use these drugs in a way that led to dependency. Drug manufacturers that encouraged doctors to overuse opioids are now facing lawsuits for their role in creating the opioid epidemic.
No one is immune to opioid addiction. These drugs work at the cellular level, well beyond the point where one can control any of the chemical processes occurring in the brain. Addiction hijacks a person’s ability to control their impulses and can cause hundreds of changes in brain functioning. While it’s true that many people addicted to opioids made a bad choice at some point, once physiological dependence takes hold, it’s simply not possible to choose not to be addicted.
Falsely characterizing addiction as a moral failing led to another epidemic — the epidemic of silence that so often surrounds overdose deaths. The stigma and shame imposed on family and friends and the pressure to attribute the deaths of their loved ones to accident or suicide has allowed the opioid crisis to flourish in secret: Americans haven’t understood the enormous scale of this crisis until recently.
To regain control of the opioid emergency, we must treat the underlying reasons Americans typically begin misusing these drugs: unemployment, poverty, mental illness, and lack of adequate healthcare. But we must also stop the routine overuse of prescription opioids, particularly when they’re often unnecessary for pain relief. Because opioids carry such significant risks of dependency, doctors simply shouldn’t prescribe these drugs unless there’s no other reasonable alternative.
After declaring an official national health emergency, Congress and the White House should take full advantage of the power and reach of the Centers for Disease Control. Working with experts from the American Medical Association, pain control associations, and state boards of health, Congress should enact laws to limit prescriptions and strictly enforce a national monitoring program to track opioid prescriptions in order to better identify the doctors and patients who overuse. Prescription opioid monitoring programs already exist; it makes no sense not to use one consistently nationwide.
We must make it as easy as possible to access effective medical treatment for opioid dependency, and we should never have to turn away a potential patient due to lack of funding. Needle exchange programs and safe injection sites dramatically cut down on accessory health problems like hepatitis, HIV, and deadly overdoses. Federally controlling the price of the overdose reversal drug naloxone (Narcan) will help get it into the toolkits of every single first responder in the nation.
To prevent addiction, we must seek out better alternatives to opioids by funding research into medicines that maximize painkilling without unwanted side effects such as dependency. Congress should also curb drug companies’ ability to endlessly rebrand their opioid products, which keeps them highly profitable and drives drug companies to push them too aggressively. Education programs, especially in at-risk areas, are an effective way to warn patients, doctors, and the general public about the deadly dangers of opioid overuse and abuse.
Unassailable evidence and expert consensus tells us over and over again that opioid dependency is a disease, not a choice. Our leaders must stop characterizing those struggling with addiction as degenerates who deserve to suffer the too-often deadly consequences of opioid dependency. When someone suffers injuries as a result of other bad decisions, we do not send them to prison — we treat their injuries and try to help other people avoid making the same mistake. Opioid addiction is no different: it is a medical problem with medical treatments.