Statewide View: Winning the drug war? We’re getting it all wrong with opioid-addiction policies
The unprecedented scourge of opioid overdose deaths, which is devastating the Midwest, has not spared Minnesota. Like most other states in the region, increases in deaths have skyrocketed — by as much as fivefold within a few years.
Unfortunately, it appears Minnesota is heading down the same misguided path that kickstarted the nationwide plague seven years ago — simply stopping the pills.
Minnesota's state Attorney General Lori Swanson recently joined her Wisconsin counterpart Brad Schimel in a media campaign called "Dose of Reality." It seeks "to raise awareness about how to safely use, store, and dispose of opioid prescription painkillers." Both Swanson and Schimel have bought into a false narrative that sounds plausible but has, in fact, had the opposite effect, hurting both addicts and pain patients alike.
Much of the narrative is a result of bungling at the Centers For Disease Control and Prevention. The agency, which failed to understand addict behavior, developed a naïve and simplistic strategy that may have sounded reasonable but backfired horribly. Turning off the spigot of opioid medications at the pharmacy has been an unmitigated disaster by any measure.
Addicts are dying in record numbers, but not from pills such as Vicodin or Percocet. This is the false narrative. The real killers are injectable narcotics like heroin and its evil cousin fentanyl. Perhaps worse, patients with severe pain who have been living barely tolerable lives now must fight increasingly Draconian regulations to obtain the medication they need to survive.
We should have learned our lesson in 2010, the year abuse-resistant OxyContin was approved. The evidence was there for all to see. As OxyContin use plummeted, addicts switched in droves to heroin. This should have, but did not, prevent another false narrative: that today's deluge of addiction resulted from over-prescribing opioids to patients with legitimate needs who later became addicts.
Is the narrative convincing? Yes. Accurate? Anything but. Multiple reviews — including a systematic, evidence-based analysis known as a "Cochrane Review" of 26 studies — and a 38-study review in the journal Pain concluded that a very small number, about 10 percent, of people who took opioids to manage pain become addicted. Rather, the vast majority of today's addicts became so because of the recreational use of opioid pills; they later progressed to injectable narcotics once the pills became prohibitively expensive and difficult to obtain.
Beginning around 2013, an already-bad situation began to worsen. The demand for heroin became so great it was supplemented with, or replaced by, fentanyl, which is not only far more dangerous but also very easy to synthesize. Even chemists with marginal skills, mostly in China, can prepare large quantities of the drug in a short period of time. From there, it makes its way to Mexico, the source of virtually all fentanyl in the United States.
The result of this confluence of events could not be clearer. In Massachusetts, during the first quarter of 2016, more than 90 percent of overdose deaths involved fentanyl, heroin, or both, compared to 10 percent for prescription opioid pills. Data from the departments of health in Ohio, Philadelphia, and Florida show that heroin and/or fentanyl is responsible for about 80 percent of opioid overdose deaths. Kentucky, despite a crackdown on pill mills and doctor shopping, ranks third in the nation in heroin/fentanyl deaths, which have tripled since 2010.
The notion that the unwinnable war on drugs can be won by counting Vicodin prescriptions is perversely wrong. The crack and methamphetamine epidemics did not begin from prescriptions. Neither did this one.
Worse still, the federal Drug Enforcement Administration is now seizing deadlier analogs of fentanyl, some of which are over 100 times more potent. Overdose deaths will only increase as these "super fentanyls" make their way into bags of "heroin."
The lesson we should have learned in 2010 is that the only policy worse than not restricting opioid pills is over-restricting them. Pain patients suffer, and more addicts die. Everyone loses.
Jonathan "Josh" Bloom is the director of chemical and pharmaceutical sciences for the American Council on Science and Health in New York City (acsh.org).