Rutgers professor weighs in on Democrats debating opioid epidemic

<p>Assistant Professor at Rutgers School of Social Work Dr. Jamey Lister.</p>

Assistant Professor at Rutgers School of Social Work Dr. Jamey Lister.

Last Tuesday, 12 Democratic hopefuls took the stage in the fourth Democratic presidential debate. Among many issues, they discussed the opioid epidemic. 

The phrase "opioid epidemic," said assistant professor at Rutgers School of Social Work Dr. Jamey Lister, refers to the rise in opioid overdose deaths that occur in response to the over-prescription of opioid medications for pain. Those rates have declined or stabilized while death rates due to illicit opioids like heroin and fentanyl have been rising.

“No candidate directly identified plans for addressing the opioid epidemic,” he said.

Andrew Yang, despite using the stigmatizing term “addicts” and implying that naloxone kits, or Narcan, are a crutch, made some good points, Lister said. He pushed for decriminalizing possession of small amounts of opioids like heroin as well as life-saving safe injection sites around the country. 

Yang also mentioned treatment, but could have clarified what he meant, Lister said.

“He suggested people get referred to treatment and counseling instead of a prison cell, which is good. However, it’s unclear if he means evidence-based medication treatment. The biggest issue in the field is not that people don’t get treatment. It’s that they don’t get evidence-based medication treatment, and often get referred to abstinence-based treatments or Narcotics Anonymous meetings that place people at high risk for overdose deaths when and if they relapse,” he said.

Other candidates like Amy Klobuchar (D-Minn.) referenced the addiction history in her family in an attempt to reduce stigma and show that opioid use disorder can happen to anyone, Lister said. She then went on to imply the value of 12-Step programs like Alcoholics Anonymous. 

The dialogue also failed to mention the communities that are most affected by the opioid epidemic, he said. The question that came up in the debate was about the rural opioid epidemic.

“Rural communities have had a rapid increase in opioid deaths, but in the last few years, the trend has shifted a little bit where now urban communities are more likely to experience overdose deaths. African American populations also saw the steepest increase in overdose death rates between 2016 and 2017,” Lister said.

People living in poverty or living at working-class income levels are more likely to develop opioid use disorder than someone who is living at middle or upper-class income levels, he said. Of the top 10 counties with the highest per capita overdose death rates in New Jersey, eight are also in the top 10 for poverty, he said.

“In impoverished communities, there’s these diseases of despair: suicide, homicide, long-term health problems from alcohol use that just arise in areas where people are living in chronic poverty. Opioids, at least in the short term, work well to numb people out from physical and emotional pain when they’re not able to access healthcare," Lister said.

Candidates also focused on the tragedy of people dying from overdose deaths with thoughts, prayers and energy, he said. They scapegoated big pharmaceuticals but did not address expanding access to high-quality treatments.

“There wasn’t any plan of substance, that I heard, that described how to expand access for people to evidence-based medication for treatment, like Suboxone or methadone,” Lister said.

Instead, the candidates discussed expanding general healthcare access for more Americans. The plans, particularly those described by Elizabeth Warren (D-Mass.) and Bernie Sanders (D-Vt.), may not address treatment for opioid use disorder even if they are supported financially and by the government, he said.

“It would give people more access to healthcare, but there are still far too few providers of evidence-based medication treatment,” Lister said.

The candidates also did not discuss the barriers people face to get treatment, like the distance they have to travel to reach a medical provider, he said. Their lack of understanding could be due to the complexity of the issue.

“It’s a very complex system and to some degree the candidates are staying out of weighing in because they might feel out of their depth given the complexity of the issue. Broad blanket statements on healthcare are good but they have to be taken to task on why they may not work for the opioid use epidemic,” Lister said.

The change has to be systemic, and requires all stakeholders to work together, he said.

“Everyone’s responsible. Everyone has been trying. I don’t look at it and say the federal government isn’t doing enough. This problem is so complex that it really requires multidisciplinary collaboration between community members, academics and state leaders,” Lister said.

At minimum, candidates should have a greater understanding of what is considered the gold standard in treatment and underrepresented communities, he said.

“I think the real danger is not that politicians need to know as much as a healthcare specialist knows. It’s that they push out outdated narratives that continue to make certain communities feel overlooked,” Lister said. “Candidates also have a platform to say that the science is clear: If we can get more people into Suboxone and methadone treatments, we’re going to save a number of lives in the next few years.”

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