Summer 2017—The Opioid Epidemic:  Where Are We Now?

The good news is that the number of opioid prescriptions being written by doctors is starting to decrease. The number peaked in 2010, but since then, prescriptions for high, dangerous doses have dropped roughly 41 percent. To put that in perspective, the prescribing rate in 2015 was triple the rate in 1999, when the current opioid problem began. The reasons for the decrease range from tighter state and insurer limits on how many pills can be prescribed, to stricter regulations concerning pain clinics, to a new set of prescription guidelines released by the CDC in 2016.

However, there’s still much work to be done – and that’s putting it mildly.

Many people are looking to President Trump and the new administration in Washington to help end the epidemic. When he was elected, President Trump said he’d make the opioid crisis a priority, and addiction experts raised their voices in support of swift and forceful action. On March 29th, 2017,  two months after being sworn into office, he signed an Executive Order establishing the Commission on Combating Drug Addiction and the Opioid Crisis, and appointed New Jersey governor Chris Christie to head the commission. Christie convened the commission’s first meeting in June and recently issued an interim report. He promised to deliver a final report in October.

The commission advised Trump to declare the opioid crisis a national emergency. The report does not shy away from the facts, stating “The opioid epidemic we are facing is unparalleled. The average American would likely be shocked to know that drug overdoses now kill more people than gun homicides and car crashes combined.”

The report makes several recommendations, including:

  1. Mandating prescriber education and training for both opioid prescribing and the risks of developing a substance use disorder.
  2. Rapidly increasing treatment capacity.
  3. Eliminating barriers to treatment resulting from exclusions within the Medicare program.
  4. Expanding access to medications that help treat opioid addiction.

(Read a full draft of the interim report here.)

It remains to be seen where all this will lead. Not everyone is hopeful. Michael Fraser, the executive director of the Association of State and Territorial Health Officials, recently told The New York Times, “It’s really about drawing attention to the issue and pushing for all hands on deck. It would allow a level of attention and coordination that the federal agencies might not otherwise have, but in terms of day-to-day lifesaving, I don’t think it would make much difference.” One governor called the report incomplete because it doesn’t do enough to ensure that people with mental health and substance abuse issues have access to healthcare.

In another development, a report appeared this summer describing a new legal tactic to battle the opioid crisis: in one area on the east coast, prosecutors began charging drug dealers with second-degree manslaughter and criminally negligent homicide if they could prove the dealers were responsible for an overdose death. In such cases, prosecutors are required to provide evidence that the accused “knew the risks of the drugs yet provided them anyway.” Observers point out that this requirement could be problematic, since defense lawyers might argue that drug dealers want to cultivate customers, rather than kill them.

Meanwhile, the epidemic rages. The CDC estimates that 142 people die every day from drug overdoses. As with most bureaucracies, organizations like President Trump’s new commission tend to move slowly. Unfortunately, where the opioid epidemic is concerned, there is no time to lose.