Why Can’t We Learn from Our Opioid Mistakes?

Few policymakers consider the roots of America’s drug problem when they pass legislation aimed at curbing substance abuse and addiction. The Trump administration seems headed down the same road.

In July 2015, a high school athlete overdosed on opioid prescription painkillers, after a long drawn-out attempt to get off them.  He was one of tens of thousands killed by opioid addiction in this country yearly.  Yet policymakers never fully consider the contributing factors to this problem when they pass legislation aimed at addressing what many people are now calling a health crisis.

And we seem unable to learn from our mistakes.

For instance, the US government aimed to reduce the supply of heroin by spraying coca fields (which produce the main ingredient for crack and cocaine) in Colombia. But federal policymakers failed to do anything about the country’s poppy fields (the main ingredient for heroin.

Seemingly as a result, deaths by heroin overdoses between 2002 and 2013 rose by 286%, according to the CDC.

Policymakers at all levels have repeatedly failed to consider why their policies don’t succeed. Worse, they overlook the unintended consequences of their actions, which can create undue suffering to users.

The lesson is certainly being ignored by the Trump Administration, which appears ready to continue Washington’s support for  “Plan Colombia”.

But these types of failures aren’t limited to the federal government.

In 2010-2011,  Florida regulated opioid painkillers through prescription drug monitoring programs (PDMPs).  The result was a 28% decline in painkiller deaths, but this was undermined by a 122% increase in deaths from heroin overdose.

Florida policy makers fell into the same trap the federal policymakers did: They did not fully consider their actions and only acted on part of an overall problem.

Along with these government failures, healthcare providers are also guilty of not fully considering the consequences of their treatments.

Consider, for example, the way methadone treatments are currently used.  The treatments are a method of easing the withdrawal of patients by using methadone (another opioid).  But the drug, while less harmful to the body and effective in preventing withdrawal, is just as addictive as heroin and its withdrawal symptoms are just as brutal.

This more socially acceptable addiction can make people emotionally dependent, as they will believe that they are not strong enough to fully phase off of methadone.  It becomes their only ticket for a “normal” life.

Another issue plaguing the healthcare system is chronic over-prescription.  Doctors have been prescribing opioid painkillers and other medications to an extreme degree over the past 25 years, leading to a ballooning number of painkiller related deaths and addictions.   Now that the DEA is trying to regulate this overprescribing, many of the addicted will likely follow suit with the Florida example.

Law enforcement in the United States is the most vivid example of poorly thought-out responses to opioid use.  The current favorite method is mass incarceration, with a heroin possession minimum charge in the US on average having a one year sentence. The offender is taken away from the outside world to sit in a jail cell as a criminal for what has become a medical issue.

According to the National Criminal Justice Treatment Practices Survey, convicts are four times more likely than the general public to have a substance abuse problem, and only 10% of them receive treatment.

There is a racial aspect to this epidemic as well.  The “treatments-over-incarceration” trend only really began when the face of drug abuse started to include young suburban whites. This means that the lack of proper policy regarding opioid addictions was partially racial, and became part of the reason for the current disproportionate incarceration of minorities.

There’s no good solution to this epidemic that can be offered in an Op Ed column, but attention to cost and availability provides a good framework. When forming policies, such as Plan Colombia or the Florida monitoring programs, these two dynamics are typically ignored.

This suggests that the government will support the same types of treatments discussed earlier, without an effort to fine-tune them so they produce the results everyone wants.

The administration’s war-on-drugs vocabulary hasn’t changed from the mindset that created mass incarceration.  To top it off, the proposals so far on the table to eliminate the Affordable Care Act would make it difficult for many sufferers to receive proper rehabilitation treatment.

Jessica Fuentes-Diaz

Instead, upgrading our current policies would better address the nation’s substance abuse issues; for example, working on PDMPs could save many lives.

These programs are very effective in dropping the rate of painkiller abuse, as shown in the Florida example, but fail to stop people from switching over to more dangerous drugs.  The programs should be augmented with a net that flags individual prescription information for those who are potentially addicted, and those found at risk due to doctor over-prescription or other circumstances should be placed under a monitoring program.

This monitoring could be accomplished through drug tests or community support, and if people are found to have continuing substance-abuse issues they can be brought under the wing of health care officials.  This increases the social and legal cost of any drugs.

James McAdoo II

Similar attention to detail should be placed on other policies and programs with no expense spared.  The people suffering from this spreading health crisis deserve our full attention.

Considering how much we spend on incarceration, we can afford to give a little help.

James Alexander McAdoo II and Jessica Fuentes-Diaz are students at George Mason University. James studies Conflict Analysis & Resolution, and Jessica’s area of concentration is global affairs.  They welcome comments from readers.

 

from https://thecrimereport.org