WASSERMAN: Current response to opioid crisis is lacking
Opinions Column: A Healthy Dose of Justice
Accurately capturing the extent of America’s opioid crisis is a challenging task. Even as headlines like “The First Count of Fentanyl Deaths in 2016: Up 540 percent in Three Years” fill the media landscape, a Centers for Disease Control and Prevention (CDC) report from April 2017 indicated that opioid-related deaths may still be understated. Regardless of data discrepancies, there is no doubt that substance abuse is making America gravely ill, and action needs to be taken in order to prevent further suffering and death.
On Oct. 26, President Donald J. Trump declared the opioid crisis as a “public health emergency,” which sounds much more impactful than it actually is. Declaration of a public health emergency allows the Trump administration to accelerate temporary appointments to handle the opioid crisis, work with the Drug Enforcement Administration (DEA) to expand telemedicine access for certain groups and provide new flexibilities within HIV/AIDS programs. Trump’s declaration provides no additional funding for the federal government to be able to accelerate efforts to combat opioid deaths, despite urging from the White House Commission on Combating Drug Addiction and the Opioid Crisis to declare a “national emergency” under the Public Health Service Act or the Stafford Act. If the Trump administration had declared a national emergency, they would have had access to funding from emergency response budgets, removed barriers for access to life-saving prescriptions and nationwide distribution of Naloxone by the Food and Drug Administration (FDA).
The opioid crisis is complicated by the fact that it involves both heroin, an illegal substance, and prescription painkillers that are legal when ordered for use by a doctor. The introduction of fentanyl, a synthetic opiate that is 50 times more potent than heroin, into the illegal market in 2014 dramatically increased opioid-related deaths. Initially, the epidemic was rooted in over-prescription of opioids for acute and chronic pain, though deaths from prescriptions have leveled since around 2011. With a multi-pronged etiology that resulted in the worst drug crisis in American history, any silver bullet fix to slow the impact of the opioid crisis and save people from untimely death is a far-fetched dream.
I believe this warrants discussion of a few fundamental problems with the way that we handle substance abuse in the United States. A blurred line divides criminalization and medicalization when handling drug problems, with neither side being sufficient enough to distribute wellness across the large swaths of America that are directly or indirectly suffering from addiction.
On one side, insurers like UnitedHealthcare have limited drugs that they will cover, eliminating less addictive options and forcing consumers to have to purchase opioid painkillers for chronic pain. In doing so, insurers save money at the expense of people’s lives and risk forcing them to take illicit drugs for pain management. Additionally, 30 percent of non-elderly adults suffering from opioid addiction are covered by Medicaid, indicating an inherent contradiction between the Trump administration’s prioritization of stopping the opioid crisis and their continued attempts to repeal and replace the Affordable Care Act with the expansion of Medicaid.
On the other side, there are contradictions within the way that we criminalize addiction. In a 2016 op-ed, Yeshiva University Professor Ekow Yankah wrote on the historical differences in drug policy as it relates to race, “White heroin addicts get overdose treatment, rehabilitation and reincorporation, a system that will be there for them again and again and again. Black drug users got jail cells and ‘Just Say No,’” indicating that the greater attention on the opioid crisis is reflective of a society that places weighted value on the lives of individuals and communities by the color of their skin. Due to this, evidence shows that death rates from opioid use have increased among Black people, Hispanics and Native Americans since 2010. The lack of prioritization on treatment and rehabilitation in the 1970s and 1980s epidemics of heroin and crack cocaine, in contrast to the newfound holistic approaches to tackling the opioid crisis, holds distinct racial undertones that ought to be recognized.
I do not claim to know what the solutions to the opioid crisis are, but what I do know is that our current response is insufficient to prevent further death and suffering as a result of opioid usage. In order to bolster a coordinated, cross-sectoral response to decrease overdose deaths, increased funding is going to be required, as well as a renewed sense that it is the responsibility of the healthcare community and the justice system.
Jake Wasserman is a Bloustein School senior majoring in public health with a minor in cognitive science. His column, “A Healthy Dose of Justice” runs on alternate Tuesdays.
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