Opioid Addiction: A Crisis Deferred

Dan Baker was introduced to opioids at the age of 21, to treat an old back injury he had obtained while playing sports. Despite being aware of the addictive nature of the drug he decided to push through with the treatment. A few months later he was being committed to a clinic for opioid addiction. Dan’s father would later admit: “We weren’t sure he was as committed to treatment as we thought he should be. We let him know: You can choose this life. We can’t make you do this the way we want you to. That was the last time we saw our son alive.” Dan was subsequently kicked out of this treatment center for sharing drugs with his roommate. His roommate’s father picked his son and Dan up and, at their request, allowed them to attend one last party in Minneapolis. Dan was found dead the next morning, having passed away at the age of 25 (Magan).

OxyContin hit the market in 1996 and, thus, began the circulation of what was seen at the time as the new standard in pain medication. Purdue Pharma, the manufacturers of OxyContin, aggressively promoted the product to the medical community. Between its initial release in 1996 to 2001, Purdue held more than 40 “national pain-management and speaker-training” conferences in resorts across the country. Professionals across the medical field from physicians to pharmacists were invited to these seminars, at no personal expense, to hear about the practical applications of this new drug. Art Van Zee, reports, “It is well documented that this type of pharmaceutical company symposium influences physicians’ prescribing. . .” (Zee).

This proved to be true, as in the early 1990s, the number of painkiller prescriptions issued had been steadily increasing by 2 to 3 million a year, however; the number of prescriptions inexplicably jumped by 8 million in 1996 after OxyContin’s release. This number would jump to 11 million in 1999, a year after Purdue released a promotional video to be used in “physician waiting rooms as a ‘check out’ item for an office’s patient education library”  (Moghe). In this same span of time, Purdue saw their sales rise from $48 million in 1996 to $1.1 billion in 2000 (Zee).

It wouldn’t be until 2007 that Purdue and three of its executives would be charged for downplaying the addictive nature of the drug, culminating in $635 million settlement with the U.S Government. By this time OxyContin was already a leading drug of abuse in the United States. Purdue re-marketed their drug in 2010 with new “abuse deterrents” put into place, making the pills more difficult to crush to discourage abuse through snorting or injecting. According to a study conducted by the staff of the New England Journal of Medicine, while this move did help decrease the number of opioid abusers, OxyContin’s nature as a gateway drug had already spiraled the situation out of control. As one opioid user interviewed in the study asserted, “Most people that I know don’t use OxyContin to get high anymore. They have moved on to heroin [because] it is easier to use, much cheaper and easily available” (Moghe).

As of January 2018, more than 90 Americans die every day from overdosing on opioids, this including prescription pain relievers, heroin, and fentanyl (“Opioid”)—a synthetic opioid 50 times more powerful than heroin (Korte). When wondering why this crisis doesn’t seem to be abating, one simply needs to look at the country’s lack of preparedness in our substance abuse facilities. Out of 12,051 substance abuse facilities, only 41.2% offer at least one medication for opioid addiction. Furthermore, only 2.3% offer all three medications currently available to combat opioid addiction (Lopez).

What seems to be holding back holding back the wide availability of these medications, such as Suboxone, is that these medications are opioid themselves. However, since these medications are opioids they can fulfill a person’s cravings, as well as prevent the suffering of withdrawal symptoms. Moreover, in a medical setting where these drugs are prescribed and controlled, the opioids do not produce the “euphoric high” for patients like they do when abused. Various studies have shown that medication- assisted treatment cuts down the mortality rate of addicts by half or more (Lopez“There’s”).

Nevertheless, past administrations have tried other methods to regulate this growing addiction problem. The current President issued a 90-day public-health emergency, set to expire Jan. 23, in an effort to mobilize governmental efforts to combat the crisis. The declaration effectively “allows the quick hiring of personnel to deal with the issue, [expands] access to telemedicine services, such as remote prescribing of medicine, and [promotes] flexibility in [the] use of grant money” (PolitiFact). Many were surprised by the classification of the opioid crisis as a public-health emergency as opposed to a national emergency which, under the Stafford Act, would have allowed the administration to draw money from the Disaster Relief Fund to use in their efforts.

Official designation aside, besides drawing greater awareness to the situation, the declaration of a public health emergency has yielded no concrete moves in stifling the epidemic. Public Health Commissioner Rahul Gupta of West Virginia, the state with the highest death rate from drug overdose in the country, commented on the situation: “[Trump’s] thoughts and prayers have helped, but additional funding and resources would be more helpful” (Ehley). In conjunction with the lack of significant change, since the President has yet to nominate a director for the Office of National Drug Control Policy, a position that usually heads federal strategy to combat addiction, it is unclear who would have the authority to carry out any large scale operation in the first place (Ibid).

In response to the accusations of inactivity, members of the administration have pointed to the passage of the International Narcotics Trafficking Emergency Response by Detecting Incoming Contraband with Technology (INTERDICT) Act as proof of the government’s efforts since the health emergency was declared. On January 10th, President Trump did sign the Interdict Act, providing $9 million to U.S Customs and Border Protection for additional chemical screening devices that can aid in detecting the drugs as they enter U.S territory. These drugs, however, still remain difficult to detect in small amounts despite screening tests (Korte). Nevertheless, as Politico reports, this act was originally proposed in March of last year, well before the emergency state was issued. 

Most of the administration’s efforts have been strangely concentrated outside of the 90-day period of the issued health emergency. Prior to the declaration, government has already issued “new guidance for states trying to expand access to inpatient treatment and to advance research into non-opioid pain management. The Food and Drug Administration also approved a new 30-day injectable treatment for addiction, and the National Institutes of Health is working with the pharmaceutical industry to come up with new pain treatments. The Centers for Disease Control and Prevention recently launched an awareness campaign warning about the risks of addiction” (Ehley.)

However, these efforts are not enough in the long term fight against opioid addiction. State health officials and policy experts have estimated that it will require billions of dollars in new and continued funding to make a dent in this crisis. As it stands the Public Health Emergency Fund, which Health and Human Services has access to under the Trump declaration of a public health emergency, currently has a balance of just $57,000. At this time there has been no moves to replenish this fund (Ehley).

Works Cited

Ehley, Brianna, et al. “Trump declared an opioids emergency. Then nothing changed.” POLITICO, Politico , 11 Jan. 2018, www.politico.com/story/2018/01/11/opioids- epidemic-trump-addiction-emergency-order-335848.

Lopez, German. “There’s a highly successful treatment for opioid addiction. But stigma is holding it back.” Vox, Vox, 20 July 2017, www.vox.com/science-and-health/ 2017/7/20/15937896/medication-assisted-treatment-methadone-buprenorphine- naltrexone.

Lopez, German. “To understand why America’s opioid epidemic keeps getting worse, just look at this map.” Vox, Vox, 10 Jan. 2018, www.vox.com/2018/1/10/16872012/opioid-epidemic- medication-addiction-map.

Korte, Gregory, and David Jackson. “To combat drug smuggling, Trump signs bill to provide $9 million for opioid sensors.” USA Today, Gannett Satellite Information Network, 11 Jan. 2018, www.usatoday.com/story/news/politics/2018/01/10/combat-drug-smuggling-trump- signs-bill-provide-9-million-opioid-sensors/1022548001/.

Magan, Christopher. “How opioids ruined three lives – one of them forever.” Twin Cities, Twin Cities, 26 Dec. 2017, www.twincities.com/2017/10/07/personal-stories-of-opioid- addiction-and-loss/.

Moghe, Sonia. “Opioids: From ‘wonder drug’ to abuse epidemic.” CNN, Cable News Network, 14 Oct. 2016, http://www.cnn.com/2016/05/12/health/opioid-addiction-history/index.html.

“Opioid Overdose Crisis.” NIDA, National Institute on Drug Abuse, 4 Jan. 2018, http://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis#four.

PolitiFact, and Donald Trump President https://www.whitehouse.gov/the-press-office/ 2017/10/26/remarks-president-trump-combatting-drug-demand-and-opioid-crisis. “What Trump’s declaration on opioids really means.” PolitiFact, 30 Oct. 2017, www.politifact.com/truth-o-meter/article/2017/oct/30/opioid-epidemic-united-states-and- trump-administra/.

Zee, Art Van. “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy.” American Journal of Public Health, American Public Health Association, Feb. 2009, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/.

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