How to Respond to the Opioid Epidemic

James Dail CM ’20 – The United States is in the midst of its worst-ever drug crisis. Every day 91 Americans die from opioid overdose.1 To make matters worse, the crisis is not affecting all facets of American society. Poor and working class Americans bear the brunt of the carnage.2 Unless viable solutions are devised, these communities will continue to be devastated as they continue to face apathy from the rest of the United States.

The first thing that needs to be examined in this crisis is the role of the opiate as a pain reliever. The crisis can trace its origins back to the 1980s when doctors began prescribing it for chronic pain.3 Thus, one way of successfully combating the epidemic would be to offer a method of pain relief that is not as addictive. Medical marijuana has the power to do this. A study conducted by the JAMA Network in 2014 found that states that have either recreational or legal marijuana have lower rates of opioid abuse than states that do not.4

Alternatives to prescription painkillers are even more critical if policymakers choose to defeat the epidemic by cutting it off at the source. Doctors need to be incentivized to stop overprescribing opioids. Opioids are only effective at relieving short-term pain from injuries such as broken bones. They perform poorly at alleviating long-term pain.5 The government can help ensure that prescription painkillers will not be abused by limiting prescriptions to a short-term period. Twenty-three states and the District of Columbia currently have such laws.6 Additionally, the government can also take an active role in ensuring that, even when opioids are prescribed, the rate of addictions goes down. Though they are not prevalent on the market, the government can require that abuse-resistant measures, such as making painkillers hard to crush, be employed in painkiller development. A study published in the New England Journal of Medicine found that when these anti-abuse measures were added to opioids, the rate of chronic abuse dropped from 35.6% to 12.8%.7

While opioid use has increased all over the United States, Appalachia and the Rust Belthave both been hit particularly hard.8 This, combined with data demonstrating that poor and working-class Americans are being hit the hardest by the epidemic, suggest that a manufacturing decline may be partly responsible. These regions have been particularly hard-hit by automation, and a lack of good jobs could be fueling this epidemic. People who have lost their dignity are particularly prone to addiction.

The obvious solution to widespread economic hardship in those regions is to invest in small towns. Progress is being made, but it is slow. Recently a startup has launched in Kentucky with the goal of training coal miners to become coders.9 An idea to delegate parts of the federal government to parts of the country that need investment has also been tossed around. This could attract professionals to parts of the country that need investment, and provide an abundance of service jobs for those who currently live there. The government could also launch a sustained effort to train people in small towns to do other types of work. It will provide a safety net against the sort of hopelessness that fuels addiction. These people are hopeless, and their hopelessness needs to be addressed.

While they will all be effective in some way, none of these policies will be a panacea on their own. Each one targets a different aspect of the opioid crisis. They have to be utilized together if real progress against opioid abuse is to be made.

 

1https://www.cdc.gov/drugoverdose/epidemic/index.html

2https://www.cdc.gov/vitalsigns/heroin/infographic.html

3http://www.cnn.com/2016/05/12/health/opioid-addiction-history/

4http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1898878

5http://www.consumerreports.org/cro/2014/01/5-surprising-things-you-need-to-know-about-prescription-painkillers/index.htm

6https://www.cdc.gov/phlp/docs/menu_prescriptionlimits.pdf

7http://www.cnn.com/2016/05/12/health/opioid-addiction-history/

8https://www.cdc.gov/drugoverdose/data/statedeaths.html

9http://www.npr.org/sections/alltechconsidered/2016/05/06/477033781/from-coal-to-code-a-new-path-for-laid-off-miners-in-kentucky

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