Opioids

Trump's Weak Response to Opioid Overdoses

More innovative remedies will be needed to actually turn back the relentless onslaught of overdose fatalities.

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Douliery Olivier/Sipa USA/Newscom

You'd think it would be impossible to kill 100 people a day, every day, without inducing widespread shock and deafening demands for action. But that's what opioids have been doing for the past decade, and Americans have given it only passing attention. This year, the toll is expected to rise to 175 a day—64,000 in all.

On Thursday, it looked as though President Donald Trump would address the problem with the urgency it demands. But his speech was blighted by his usual oratorical crimes: deep self-infatuation ("I've never had a drink"), bloated adjectives ("tremendous," "horrible"), cheap promises (changes "will come very, very fast"), and swipes at President Barack Obama ("not like in the past").

Trump went through a roster of fraudulent cures, such as building a border wall, demanding that China crack down on shipments of the powerful opioid fentanyl, and "really tough, really big, really great advertising" to discourage drug use.

We know from experience that no amount of enforcement can stamp out the demand for or the supply of illicit substances. If fentanyl stopped arriving from China, which isn't likely, it would soon pour in from black-market labs in other countries, including this one.

Anti-drug ads are irrelevant to those who develop a dependence on opioids prescribed for severe pain. And people in communities where opioid-laced corpses are piling up don't need to be informed that these drugs are dangerous.

The public health offensive Trump declared is mostly a form of yoga: lots of posturing while staying in one place. More innovative remedies will be needed to actually turn back the relentless onslaught of overdose fatalities.

Some people around the president are better connected to reality. On Wednesday, the commissioner of the Food and Drug Administration acknowledged to a House committee that the biggest need is a huge expansion of treatment for those dependent on opioids.

Scott Gottlieb testified that therapies using methadone or buprenorphine have been proved safe and effective in combating addiction. Massachusetts, for example, found that they cut the risk of death by overdose by 50 percent among people who had survived previous overdoses.

But the remedy works only for those who get it. "Unfortunately, far too few people who are addicted to opioids are offered an adequate chance for treatment that uses medications," Gottlieb said. He intends to encourage doctors to offer such remedies for anyone who is treated for an overdose.

He hopes to banish the stigma of being on methadone or buprenorphine—and get people to recognize that a patient's medication-assisted treatment may last indefinitely, if not forever. We don't think diabetics should conquer their need for insulin. Why suppose that heroin addicts who are successfully treated with methadone should learn to live without it?

The FDA can help by preaching the value of medication-assisted treatment and encouraging health insurance companies to cover it.

The commissioner said this task is "part of our existing public health mandate to promote the appropriate use of medicine."

Trump offered a couple of useful small ideas, including greater access to telemedicine services—so that people in remote areas can get medications needed for drug treatment or mental illness—and letting states use HIV/AIDS funds for treatment. But the humane, evidence-based solutions generally got short shrift.

He would have done better to embrace the proposals of his Commission on Combating Drug Addiction and the Opioid Crisis, whose preliminary report stressed the need to "rapidly increase treatment capacity." Right now, it lamented, only 10 percent of drug treatment facilities offer medication-assisted treatment for opioid dependence.

The commission, chaired by New Jersey Gov. Chris Christie, recommended making it easier for states to use federal Medicaid funds for treatment. It urged the federal government to expand access to methadone and other drug therapies through Medicare, the Department of Veterans Affairs, the Indian Health Service and correctional facilities.

Dismantling regulatory barriers would also help. The Drug Policy Alliance says one big obstacle to treatment lies in rules limiting patients to one local facility that they have to visit every day for methadone instead of letting them get it in their doctors' offices. Restrictions on how many buprenorphine patients a physician can have also get in the way.

But the president himself has settled mostly for mild variations on tactics that have been tried without conspicuous success. Trump came to Washington promising to shred the status quo. But when it comes to opioids, the status quo has nothing to fear.

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58 responses to “Trump's Weak Response to Opioid Overdoses

  1. “Surely we should employ far more federal govt resources to help prevent people from suffering the consequences of their own choices.”

    /Libertarian magazine

    1. Kind of what I was thinking. These hysterias are not going to do us good in the long wrong. We haven’t ended drugs yet, and my guess that by sinking millions and billions into programs will not end it this time either. The most important thing they could do is remove laws that prevent people from acting better, but it seems the government will never sponsor a solution that doesn’t have them as the central force.

    2. Not just Chapman either, it’s more than half the Mike Riggs penned posts.

    3. I’ve heard of this term they use in drug counseling, it’s called an “enabler”.

      Definition of enabler

      :one that enables another to achieve an end; especially :one who enables another to persist in self-destructive behavior (such as substance abuse) by providing excuses or by making it possible to avoid the consequences of such behavior

      http://tinyurl.com/ycr4xa3n

      It seems to be especially clear to drug counseling that protecting substance abusers from the consequences of their misbehavior isn’t only NOT the solution–it enables the misbehavior to persist.

      One of the quotes in the piece likens opioid addicts to diabetics on insulin. No doubt, some type-2 diabetics ate themselves into their problems–there was some choice there. One difference is that refusing to take insulin anymore isn’t the cure for diabetes, but not taking opioids anymore is the very definition of beating addiction.

      Also, giving diabetics access to insulin doesn’t make them diabetics, but giving addicts eternal access to drugs does make addicts.

      1. The difference is one of dependence vs. addiction. If someone is functional on painkillers or alcohol and isn’t committing crimes to get an even bigger dose, then it’s dependence but not addiction. If someone who is dependent on a drug is denied legal access, he is almost certainly going to look for illegal access and much more likely to commit crimes such as robbery to sustain it.

        1. I didn’t make the comparison.

          “We don’t think diabetics should conquer their need for insulin. Why suppose that heroin addicts who are successfully treated with methadone should learn to live without it?”

          There is an open question as to why I should be forced to pay for either one; however, the comparison isn’t apt for various reasons. Among them, taking insulin isn’t the cause of a diabetic’s problem. It’s the solution.

          Opioids are the cause of an addicts problem, and not taking them anymore is the very definition of the problem being solved.

          1. Yet, that is the way we have been attempting to control the problem for almost a century! Doing the same thing and expecting different results…REAL SMART….(;-P

            Chronic pain patients seldom develop an addiction because they use the medication correctly. They do not get a buzz, when the pain is counteracting the “buzz”. I noticed in the special I watched on HBO that every addicts they showed was buzzed outs of his mind. Addicts harm themselves. They take more than prescribed and take it for the wrong reasons. It is improperly used it you are taking it to get a “buzz”! Non-addicts use the medications properly! Their quality of life is improved! You make the assumptions that everyone taking the pain medications are addicts.

            1. One time, I was loaded up on IV Dilaudid, after a hernia surgery, and it was not helping the pain! They gave me IV Toradol. It, completely, controlled the pain. Then I started having apnea because the narcotics, that they had loaded me with, had no pain to counteract the big dose. The anesthesiologists put me on an apnea monitor and did not let me go home until the next morning, after I had stopped having the respiratory depression that the excess Dilaudid had caused. They never figured it out! A dose or two of Narcan, and my overdose would have been alleviated. The Toradol would have controlled my pain, given orally. I could have gone home that evening, as had been planned before they gave me too much Dilaudid. Addicts will continue to obtain the drugs, no matter how hard the authorities try. Hell, the people in prison can get drugs! Continuing the war on drugs is pure insanity, due to ignorance and arrogance! Layman double that ignorance that the uneducated doctors commit! Neither has a good handle on the situation. Yet, they are exactly the people making all the damned decisions!

      2. One difference is that refusing to take insulin anymore isn’t the cure for diabetes, but not taking opioids anymore is the very definition of beating addiction.

        Also, giving diabetics access to insulin doesn’t make them diabetics, but giving addicts eternal access to drugs does make addicts.

        Too…sensible for libertarians thinking about drugs.

      1. I glanced at the synopsis, saw “Chapman” then came here to see the carnage.

  2. Trump basically promised to reinvigorate the war on drugs, e.g. the border wall and better enforcement for shipments from China. Both of which will quickly get out of hand if young people are silent as old people steal their future.

    Ironically the ‘oxy electorate‘ Frankentrumpcucks who voted him into office will be the victims of his renewed war.

    1. Yes but it will all be Comrade Hillary’s fault.

      1. nope, that fucking cunt lost.

        1. 2016 was rife with many great moments, but this was the greatest.

  3. Major outcome of renewed drug war? I predict this:

    Rich people in severe pain will still be able to see their doctor every 2 days for a prescription for 5 pills at a time (because we can’t be trusted with more than 5 pills at once, in this new era here).

    Poor people who desperately need pain relief? Their only affordable choices will be a few bottles of Mad Dog 20-20, or Thunderbird Wine, or… Suicide!

    1. That will help with the surplus population.

    2. That’s kinda been the case since forever. In the 19th century, the rich had doctors, the poor self-medicated with patent medicine. The dogooders (NOT gummint) decided that the solution was more extensive scientific training for doctors. So now the rich have doctors and the poor self-medicate with the stuff that was in patent medicines.

      1. Cannabis was one of those patent medicines. it seems to have many benefits, as discovered after its legal use was established, and studied! Some of us physicians feel that big pharma could be supporting the drug war, financially because they fear the loss of revenue!

  4. Deregulate, legalize, commodotize… If people want to ruin their lives with drug addiction, let them. Most people don’t.

    All these hoops that people need to go through to get the help they need or just to simply live their lives makes helplessness and despair far more common, which is the root cause of much of this problem.

    1. Seriously, what are the hoops? I know treatment must cost a few bucks but wouldn’t it be cheaper than having to buy street heroin mixed with God knows what that tends to kill a high proportion of users? Doesn’t the doctor who
      “addicted” you, know where treatment can be found, at various cost levels to suit their patient’s finances?

      1. You’d think it would be cheaper, but several stories about the “opioid crisis” have that it’s not, that people have turned to street drugs because they were cheaper than the prescription variety. What’s up with that?

        1. Also in the scenario where they continue usage they also get high. Giving it up they no longer get high. One thing removed oftentimes from these equations is the fact that drug usage has a benefit. It makes you feel good.

        2. That’s noinsense, opiods are cheap. Real cheap.

          Seeing a pain management doc 4 times a month is not.

          1. They’re expensive when purchased on the black market though. Government 8nterference has done nothing but stoke demand for heroin, fentanyl, and other street drugs. Which never would have happened if the fucking politicians and bureaucrats kept their nose out of our doctor/patient relationships.

            Bottom line is that some people will always abuse their meds. That shouldn’t fuck the rest of us over. Just let the addicts have their meds. Some will clean themselves up, some won’t. Othing government will do is going to change that.

          2. Well…A few years ago a relative of mine was talking about trying to work through pain. I’ve had some experience treating the kind of injury he described. The original injury had healed to the point where pain could be either cured or endured for the next 25 years or so. Massage can help. I’m no longer licensed to do the massage and he wouldn’t have felt it was decent to let a female relative touch his lower back, even through his bluejeans, anyway. But actually *stretching* can do just as much good as massage! Very likely all he needed to do was lie on the floor in the right position instead of lying on the couch while watching TV at home! I demonstrated the stretch that Pete Egoscue teaches and a local WWII hero had also used and taught. He said, “I would feel like a fool.”

            If a *doctor* had told him about this stretch, that might have got through the mental block. But what kind of doctor is going to tell anybody about something they can do at home, on their own time, at zero expense to anybody?

      2. Doctors addicted no one. The person screwed up, abused the medication, knowing full well that people get addicted from abusing them! No doctor twisted their arms and forced them to abuse the medications! Anyone thinking they will be special and avoid addiction are doing the same thing to themselves that they would be doing if they were playing Russian roulette! Don’t blame the doctors for that less than 1% of chronic pain patients that develop addiction.. That is less than addiction in the general population! The high addiction rates, quoted in these articles that are written by addictionologists. Those are the same guys who will profit by opening up drug rehab facilities, getting the government to hand out billions for the care of addicts! I read an article by one of these guys that said 60% of the population was addicted too something! That would be very profitable, especiall under Obamacare!

  5. Expanding Medicaid eligibility by way of ObamaCare was a huge contributing factor to number of new opioid addicts.

    Making more people eligible for Medicaid may seem like the solution to people who are already addicts, but it’s also a huge contributing factor to the number of new addicts.

    I’ve posted the stats here so many times before. Suffice it to say, people who qualify for Medicaid are the demographic most susceptible to addiction, ObamaCare added some 11 million new people onto Medicaid, more than 75% of people using opioids for non-medical reasons get them by way of a prescription, and more than 75% of heroin addicts started out on prescription opioids.

    That giving the demographic most susceptible to opioid addiction free, steady, legal access to opioids would increase the number of new addicts should only be surprising to people like Tony. Again, you may imagine that expanding Medicaid to cover more people will create new options for those already addicted to opioids, but what will it do to the rate of new addicts?

    You’re trying to put a fire out by covering it with wood chips and spraying it with gasoline.

    1. Ken,

      Your stats are tainted by biased studies. The real scientific studies do not confirm that 75% of patients are addicted by their doctors. If that was true, then the recent changes in prescribing patterns would have eliminated the addiction. Most addicts are dying of fentanyl overdose using clandestinely manufactured heroin/Fentanyl. Ask any chronic pain patient about the decrease in the ability to obtain adequate doses of medication to control their pain and live a decent quality of life! The prescriptions have been drastically reduced. Yet, overdoses have increased?! if it was really the doctors causing it, why has the overdose rate went up? The number of prescriptions has decreases! That has an easy answer! More addicts are dying from abusing illegal drugs and patients are not the ones contributing to that number!

  6. Legalize drugs. The end.

  7. The opiod overdose epidemic began with the government War on Opiod prescriptions. Fuck the government. They’re the worst psychopaths of all.

    1. That Road to Hell isnt going to pave itself. It needs a healthy dose of good intentions.

    2. Exactly. People weren’t dying from pills. It’s the fentanyl spiked heroine they’re using now, because they can’t get pills.

  8. Either you’re on drugs or you need to be on drugs for your TDS. Holy shit, when you’re so ate up with it that you’re criticizing Trump for not being enough of a statist in echoing the pants-shitting crisis du jour you really need to step back and take a deep breath and get a grip.

    1. Part of the problem is that Chapman is a stupid, stupid, person. Kind of like another stupid person we all know……

      https://tinyurl.com/y8qnohsh

      1. I usually have to pay extra for that.

    2. I don’t even know. If he had criticized Trump for giving into the madness of the Opioid Epidemic I would have sympathized with that argument. That it goes not far enough is just some statist bullshit.

  9. Last Thursday, it looked as though President Donald Trump would address the opioid overdose problem with the urgency it demands.

    This used to be a libertarian magazine.

    1. It started w CATO’s “Byline” radio commentaries during the Fairness Doctrine, where they took on Chapman, Julian Bond, & some others to avoid sounding too obviously libertarian. Over time I guess some of the bosses decided Chapman was one.

  10. Why does the author feel the president should spearhead any initiative on drug abuse? I’d prefer government stay out. The reasonable solution is education, not legislation.

    1. Education? Like forced education? That always works.

      1. My guess is that Andy asking for government free solutions means that he isn’t asking for forced govnerment education.

  11. Trump’s Weak Response to Opioid Overdoses

    Trump is doing more than Obama ever dreamed of doing.

    Please point me to your articles condemning Obama for his lack of response.

    Some Reason writers merely comply with Reason’s demand for obligatory Trump hating in their articles. Chapman lives for it. It is his purpose.

  12. It seems that some hate President Trump enough to abandon their Libertarian principles if it means they are able to criticize him.

    It is not government’s responsibility to protect anyone from themselves.

    1. As long as one human isn’t physically attacking or killing another in the same room, it’s not government’s business when many tens of thousands of citizens die by a known and hypothetically preventable cause. Sounds like the bestest philosophy ever!

      1. So long as assholes like you presume to offer that supposed cure, yes, the alternative is far, far better.
        You don’t know what you’re posting about as is common.

      2. Tony. We, as a society and as a nation, have enough experience with prohibition to know that the one guaranteed effect it has on drug use is to make it more dangerous. You don’t even have to be a student of history to understand that concept; the evidence is all around you. It is not, in fact, government’s business to protect you from your own foolish or reckless choices. It certainly isn’t the government’s business to punish people for what they do to themselves, or to introduce violence into situations where no violence exists. But that’s what you’re advocating when you support prohibition. More violence. More shattered families. More suffering. Less liberty, no justice. As philosophies go, yours pretty much sucks too.

  13. After Trump saves America from the Opioid problem, he’s going after the Clown Terrorists.

  14. Reason you hate Trump when he does nothing which would be libertarian, You hate trump for doing to much and you hate Trump for not doing enough. Face it you would hate Trump even if he walked on water. that is the definition of Trump deraingment syndrom.

    I don’t mine constructive criticism but that is not what we are getting from Reason

  15. Do not! … PLEASE DO NOT!!! throw even more legitimate chronic pain patients under the bus in the name of fighting the opioid “epidemic.” People are already being cut way back or off altogether, throwing them back into being unable to do much of anything but try to keep existing (not really living) and driving some to the point of committing suicide.

    1. Believe it or not, cutting off *all* medication–AT THE RIGHT POINT!–would be the best thing that could happen to some of them…at the same time that it would drive others to suicide.

      The federal government is so not the best source of a solution to this problem. Helping people get off painkillers is a very personal individual thing, and there’s nothing the federal government can do that won’t “throw somebody under the bus.”

  16. The best we can hope for from the government is a weak response to every crisis. Let things sort themselves out. People are smart enough to realize that opiods are dangerous. Just legalize everything and it will all be safer and people won’t be afraid to seek help for addiction.

  17. A good read – Time changes, but the times don’t.

    wikipedia.org/wiki/History_of_opium_in_China

  18. Why would a Libertarian want a strong response from the President on this issue? The less government involvement the better, and really, what problem is there? It’s all media hype and hysteria, ridiculous article Reason. Chris Christie? Really? Y’all have lost it on this one.

  19. What about no-pill prescriptions in the first place?!

    We’re talking about my generation here, law-abiding Christian young people who grew up spitting out the word “scag” as the lowest term of contempt we used in mixed company, who despised people who took drugs to escape from emotional pain. Then they grew up, tried to distinguish themselves by doing physical work that was outrageously in excess of what any doctor or trainer would have prescribed, tried to be the Olympic World Champions of stocking shelves or running machinery, *voted to* work twelve-hour shifts. Then injuries happened, and they wanted to work through the pain. Sometimes massage helps, for a while. Sometimes stretching and exercise help. Sometimes they just need to stop abusing their bodies, but they need the money and they won’t get another job if they’ve admitted an on-the-job injury. So they pop these pills and become addicts.

    Methadone may be all that’s left to help some of these poor slobs by now, but what about better education about ways they can treat, prevent, and recover from the injuries? What about that information coming from doctors, not merely masseuses?

  20. The only tool the government has is violence. The so-called “war on drugs” is, in fact, and always has been, an excuse for violence, mostly against unarmed, nonviolent, and often undressed Americans. And Donald Trump has made it abundantly clear that HE thinks police should be even more brutal than they already are. We KNOW this. So why, oh, why, are people calling on this man to “do something,” when the only “something” within the grasp of his feeble little mind is doubling down on the policies that caused the problem in the first place? Repeating the same behavior expecting different results is one of the commonly-accepted hallmarks of addiction. Rather than what to do about other people’s drug use, perhaps we should talk about America’s addiction to its godawful war. Because unlike MY addiction, which only becomes your problem when you make it your business, America’s addiction to punishment for its own sake affects all of us, whether we will it or not.

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