Trump and Christie’s First Steps to Solving the Opioid Crisis
President Trump has tapped New Jersey Gov. Chris Christie to tackle America’s opioid crisis—a complicated task to say the least. Because the root cause of rising addiction and overdose is still unclear, any government response must be flexible and nuanced.
The single biggest question regarding the opioid epidemic remains: Is it driven mainly by patients who become addicted to their prescriptions? Or are recreational users the underlying cause? This is difficult to figure out. Among the many heartbreaking personal anecdotes, hard data is scant and contradictory.
A 2017 report from the Centers for Disease Control and Prevention examined how patients taking painkillers respond to prescriptions of varying lengths. If a patient is initially given a one-day supply, his likelihood of still using the drug a year later is about 6%. That number rises to roughly 10% for patients given a two-day supply and 45% for a 40-day prescription.
These numbers are suspicious at best. Both a 2008 article in the Journal of Pain and Symptom Management and a systematic Cochrane review of 26 studies found that fewer than 1% became addicted. Why the discrepancy?
The CDC study does not untangle correlation from causation. A patient with chronic pain from an accident or injury would be expected to take opioids for an extended period—and also still to be taking them a year later. If long-term use of opioids is unlikely to result in addiction, short-term use for moderate to severe pain, such as dental surgery or a broken bone, would be even less so.
This points out the folly of overly strict laws now being enacted that limit prescriptions to one week, or even less. All this will do is cause patients to suffer and have little or no impact on addiction.
Further, epidemics of illegal drugs—cocaine, crack and heroin in the 1980s; methamphetamine today—cannot be pinned on pill-happy doctors or unscrupulous pharmaceutical companies. Today many millennials are dying of heroin overdoses. This generation is too young to suffer from the usual chronic pain. This suggests recreational drug use is the real culprit. Put simply, America has been awash in drugs for decades, and it is relatively easy for dealers and addicts to find them.
Given the lack of clarity surrounding the opioid epidemic, Messrs. Trump and Christie should remain open to new data. Still, here are a few preliminary ideas to help mitigate the problem:
First, don’t make people with chronic pain jump through hoops to acquire the drugs they need to function. Patients should not have to suffer for the “sins” of dealers and addicts. There is a middle ground between a generous refillable Vicodin prescription and the stingy three-day supply favored by the CDC. New Jersey law limits initial prescriptions to a five-day supply and New York law to a seven-day supply.
Second, although doctors need to be held accountable for abuse, assure them that they are not in danger of losing their licenses if they prescribe opioids in good faith. Every state except Missouri has a prescription-drug monitoring program, and 16 states require doctors to consult this database before prescribing opioids, according to Pew Charitable Trusts. In New York all prescriptions are filed electronically, so physicians can see their patients’ histories. This makes it nearly impossible for addicts to “doctor shop.” Mr. Christie should consider taking such policies nationwide.
Third, beware of unintended consequences. In August 2010, the maker of OxyContin introduced an “abuse-proof” version of the drug. The result was that addicts switched over to heroin, and overdose deaths soared. On the street, heroin is mixed with or replaced by fentanyl, a compound that is cheaper and easier to synthesize and 50 times as powerful as morphine. In Florida, according to the Miami Herald, heroin and fentanyl are to blame for about 80% of opioid overdose deaths. Other states show a similar pattern.
Fourth, understand that prescription opioids often are not taken by themselves. Roughly half the people who die from prescription opioids have taken them with benzodiazepines, such as Valium. The overdose potential from the combination is greater than from either drug alone.
Fifth, avoid anything resembling a “war on drugs.” That policy has failed miserably, and it would again, because it does not address the underlying causes of addiction. Drug addiction is an intensely personal issue, and it requires a compassionate response. Treatment centers are the only hope for addicts of heroin and fentanyl. What might have some effect, however, is a national campaign to warn of the dangers of opioids, remove the stigma of addiction and encourage addicts to come forward. Mr. Christie has already made moves in that direction in New Jersey.
Sixth, encourage researchers to develop more nonaddictive painkillers. Some experimental opioids, like PZM21 and BU08028, have shown promise. We urge pharmaceutical companies to pursue this line of research.
Once the effects of these policies have been analyzed, Messrs. Trump and Christie should work with Congress to replace the patchwork of state laws with a unified national policy. With the right laws in place to hold addicts accountable and maintain compassion, the end of the opioid crisis would be within sight.
Mr. Bloom is Director of Chemical and Pharmaceutical Sciences at the American Council on Science and Health, of which Mr. Berezow is Senior Fellow of Biomedical Science.
Appeared in the May. 16, 2017, print edition.