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Congress Needs an Opioid Intervention

Lawmakers intend to spend billions of dollars and pile on even more red tape to paper over the conundrums government itself created.

In an effort to "combat the opioid crisis" in America, Congress is calling for a slate of governmental interventions that have been tried, tested, and shown to cause more harm. In June, the U.S. House of Representatives passed 50 bills, with more to come, that throw billions of dollars at already rich universities, hand responsibility for determining addiction treatment procedures to the federal government, and allow the U.S. attorney general to ban vaguely defined substances, among many other clumsy actions. Too much of the new legislation is grounded in the "overprescription" hypothesis, which blames the current unprecedented rates of overdose on an expansion in the number of opioid prescriptions that began in the 1990s. The consensus around this theory has prompted Congress to further restrict opioid prescription access.

In responding this way, Congress is ignoring decades of its own data and a lesson Americans should have learned long ago: When government restricts access to something people want, it drives demand to the black market. In this case, as opioids have become increasingly difficult to obtain legally in the last decade, users have switched to "diverted" prescription medications and illicit alternatives, including heroin. And just as Prohibition pushed bootleggers to switch from beer to potent bathtub gin, traffickers are increasingly adulterating their narcotics with potent synthetic opioids such as sufentanil—a substance that can be up to 500 times stronger than morphine.

Thanks to prescription drug monitoring programs (PDMPs), state-level limits on the number of pills a patient can receive, and Drug Enforcement Administration (DEA) orders to reduce opioid manufacturing, prescription rates are now at their lowest level since 2006. Yet the overdose death toll over the last eight years is at a historic high.

It is true that leading up to peak prescribing, at the end of the last decade, prescription opioids caused the majority of drug overdoses. It also seems likely that the increased availability of pain relievers made prescription drugs more popular among users. (Overdoses from other drugs, such as cocaine and methamphetamine, decreased during this period as users switched to opioids.) But cracking down on those prescriptions not only failed to stem the tide of overdose deaths—it threw the crisis into high gear. The opioid overdose mortality rate has increased by more than 90 percent since 2010.

It's clear that the black market has claimed the economy ceded by restrictions on the legal market. Data from the National Survey on Drug Use and Health show that pain reliever abuse rates have been flat since 2002. Heroin abuse rates, meanwhile, increased only after opioid prescription rates started to decline.

Looking more closely at the states with the highest opioid death rates (along with Washington, D.C.) brings the problem into focus. Notice on the following chart the sharp increases in fatality numbers that follow legislated reductions in opioid prescribing. That relationship holds throughout the country and becomes more profound as the length and magnitude of opioid restrictions increase.

Joanna AndreassonJoanna AndreassonIn 2011, Ohio became one of the first states to require doctor participation in PDMPs, which force practitioners to report all opioid prescriptions to an electronic medical records database that can be raided by federal drug authorities* at any time. Prescription rates declined, but the state now has the most opioid overdoses in the country.

Legislators should have noticed the large spike in overdoses and wondered if their involvement was making the problem worse. Instead, they doubled down. Last year, Ohio lawmakers passed a seven-day limit on acute pain medications—meaning no matter what the malady, your doctor can only give you one week's worth of painkillers.

Obviously, the intention was to stem the overdose epidemic in the state. But preliminary data from the Centers for Disease Control and Prevention suggest that the total number of overdoses in Ohio likely set another national record in 2017.

Despite that failure, Ohio Sen. Rob Portman has introduced an even shorter nationwide limit on acute pain prescriptions—including for all surgeries. If enacted, patients will have to physically show up to their doctors' offices every three days to plead for a refill. In addition to being an incredible burden on people who are, by definition, already suffering, this policy is unlikely to save any lives: Opioid prescription deaths that are not the result of heroin or fentanyl use have remained constant at just under 10,000 per year since prescription rates started decreasing in 2010.

Members of Congress from Ohio are also aggressively pushing PDMP participation across the country, which risks making that state's problems nationwide.

The goal of these programs is to stop negligent opioid overprescription, but there is strong evidence that fearful practitioners are now giving people less medication than they need to keep pain at tolerable levels. Although most doctors want to prioritize their patients' needs, they are understandably willing to sacrifice patient comfort to avoid criminal prosecution, and prescriber infractions are treated differently than most crimes under federal law. The Controlled Substances Act authorizes the DEA to circumvent Fourth Amendment judicial approval and seize PDMP records without a warrant. Oregon* and Utah have both sued to stop this practice, but the courts have sided with the feds, finding that when it comes to highly regulated pharmaceuticals, "physicians and patients have no reasonable expectation of privacy from the DEA."

Evidence from abroad shows that there are far more effective approaches to dealing with an opioid crisis. In France, policy makers successfully addressed their own overdose epidemic by relaxing regulations on medication-assisted treatment, which combines addiction therapy with less-dangerous prescription opioids like buprenorphine and methadone. The result was a 79 percent drop in overdose deaths in four years. The House Energy and Commerce Committee, however, would not consider legislation that called for similar access.

Congress needs an intervention. Instead of learning from the French experience, and the unanimously positive experiences in other liberalizing countries, lawmakers intend to spend billions of dollars and pile on even more red tape to paper over the conundrums government itself created. America is not alone in grappling with an overdose crisis, yet many of our peers in the developed world are on the road to recovery. We're still searching for rock bottom.

CORRECTION: The original version of this article named Colorado, not Oregon, as a state that sued to stop warrantless seizure of PDMP records. This version also clarifies that while federal drug authorities can pull those records without a warrant, state and local law enforcement may be subject to different privacy requirements.

Photo Credit: GeorgePeters/iStock

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  • Fist of Etiquette||

    When government restricts access to something people want, it drives demand to the black market.

    I'm sorry but I'd like to think the claim of good intentions still means something in this country.

  • Woody Chip Hurrrrr?||

    So would politicians. In fact politicians still do.

  • Marcus Aurelius||

    Along with the mass of voters.

  • ipsquire||

    It does. Just not what the well-intended think it means. Results matter more.

  • Truthteller1||

    You must still be in college.

  • Fuck you, Shikha (Nunya)||

    I think you can't recognize sarcasm.

  • Spiritus Mundi||

    It means the road to hell is still being paved.

  • Jerryskids||

    Say what you will about these legislators misguided attempts to rein in the opioid epidemic, at least they're sincere. And since sincerity is the same thing as credibility to those who feel rather than think, citing facts and figures and logic and reasoning is really just mansplaining the problem and that is most certainly Not OK. Shame on you! Instead of criticizing these efforts you should be applauding them, for surely it is more noble to blindly charge into battle with no idea of who or where or what the enemy is than to carefully plan and prepare and strategize such that the outcome of the battle is a foregone conclusion. It's why we celebrate The Charge of the Light Brigade and nobody's writing memorable poetry about bombing Hiroshima - sincere ignorance trumps cold calculation.

  • Woody Chip Hurrrrr?||

    Pretty soon doctors will be making house calls again to reconfirm prescriptions every three days. MAGA!

  • SQRLSY One||

    They will personally put each pain pill in your hand, along with a lecture. And, as they do this, no doctor, anywhere, ever, will give you a fake pill and divert the real one to personal doctor use, or to the black market, because doctors, are, well, ALL perfect, having many-many years of education in and about being perfect, and are, de facto, Government Almighty employees. And Government Almighty employees never do anything bad, since their motives are good!

  • Fuck you, Shikha (Nunya)||

    And then only suppositories delivered by the doctor directly wool soon follow. Victory!

  • Fuck you, Shikha (Nunya)||

    Would follow.

  • sarcasmic||

    The other day I was listening to a radio show about disaster preparedness, and one of the things they stressed as very important was having a few days to a week's worth of prescriptions in your bug-out bag. Funny, they never mentioned a firearm or machete, but I digress. Someone called in and asked about people with pain killers who must have same-day prescriptions by law. They can't easily set aside a few days worth without skipping doses or committing a felony. The hosts didn't have an answer.

  • SQRLSY One||

    Well obviously we need a new Government Almighty program so as to fix this problem caused by a Government Almighty program! I would suggest that each and every person "bugging out" of a disaster area should be accompanied by a Government-Almighty-provided Doctor of Doctorology, carried in his or her bug-out bag, to personally prescribe each pain pill as each pain pill is consumed. THEN we can have a larger stash of pain pills in our bug-out bag!

  • ShotgunJimbo||

    We literally had a convo about this the other day at the range. 3/4 of the other guys there with me were on a slew of meds (and out of shape; honestly would be unlikely to be on said meds if they weren't very obese. Some of them were taking daily oxycodone for "back pain", and not in small amounts.

    We were talking about normal stuff: EMPs, disaster scenarios etc. I kind of jokingly told them that if they wanted to survive for any length of time they better start hitting the treadmill and get off all that shit, because an AR15 isn't going to keep Darwin from coming for you.

  • Inigo Montoya||

    I tend to agree with the late Hunter S. Thompson, who thought more people should be on drugs. Congress is a prime example. They are so dumb, drugging their brains to the hilt could only be an improvement.

    When your intelligence and judgement is already at rock bottom, which it clearly is among congress critters, it has only one direction left to go.

  • Longtobefree||

    How about we use a few baseball bats to provide each legislator with a permanent source of great pain, and see if any of these laws get repealed?
    Or just arrest all who are not doctors for practicing medicine without a license?

  • SQRLSY One||

    I see, in our future, medium-sized pez-like pill dispensers with GPS embedded. Each person who has prescribed pain pills, will have to carry these. All parolees will also have to carry GPS locators... Kinda like some auto insurance companies now have GPS devices to monitor your speeding and auto milage to give discounts to good drivers and those who drive less. The GPS-auto-pill-pez will monitor how many pills are dispensed at what time. Approaching a parolee's GPS will also be a violation, since you might sell your pill(s) to the parolee.

    Once this program will be created, the GPS-auto-pill-pez manufacturer (and associated social workers, cops, courts, and all of the usual baggage) will now constitute a special interest group that must be humored, and so the GPS-auto-pill-pez will soon be applied to ALL prescription meds!!!

    Thank You Government Almighty, may I have another!??!?!

  • MSimon||

    Dr. Lonny Shavelson found that 70% of female heroin addicts were sexually abused in childhood.

    Addiction is a symptom of PTSD. Look it up.

    Making war on the afflicted is not a moral policy.

  • ||

    As someone who has practiced anesthesia for nearly 20 years, I know a lot about this subject. There is already a cure for opiate addiction. It is very effective with few side effects. That sure is buprenorphine. Just look at the evidence.

  • ||

    As someone who has practiced anesthesia for nearly 20 years, I know a lot about this subject. There is already a cure for opiate addiction. It is very effective with few side effects. That sure is buprenorphine. Just look at the evidence.

  • Banquo||

    Dousing a rag with chloroform, sneaking up behind unsuspecting women, knocking them out by putting the rag over thier mouth, then pulling them into a windowless van is technically practicing anesthesia.

  • ||

    Legislators should have noticed the large spike in overdoses and wondered if their involvement was making the problem worse.

    No time for self-reflection. 'We got to to DOOO SOMETHING!"

    The government 'took action' against a diet pill in the '80s. The entrepreneurs of the black markets gave us crystal meth. Talk about the cure being worse than the symptom. Makes me long for the days when bloodletting and leeches were the panacea rather than legislation.

  • SQRLSY One||

    Well, today the bloodletting and leeches comes from and are the legislators respectively, so it's high time to have a food fight, just like the Germans did at Pearl Harbor!

  • Truthteller1||

    Killing addicts and the government calling the shots on pain medication management. Brilliant.

  • Inigo Montoya||

    Hey, once they passed a balanced budget and ended the 7 or so wars we're involved in, they needed to do something productive.

    It's not like hard workers can sit around wasting time and money arguing about what people did in high school 35 years ago.

    Be thankful we have "leaders" who are conscientious and dedicated to their constitutional duties!

  • Spiritus Mundi||

    Why should the government, or anybody for that matter, concern themselves with doing anything from stopping the negative consequences of poor personal choices? If people what to engage in risky behavior, it is on them.

  • Inigo Montoya||

    Ah, because when you're a power-hungry control freak P.O.S., it's fairly satisfying to control people's wallets, but it's when you can start dictating their personal choices that it really starts being fun for you and your fellow bastards in power.

  • jonnysage||

    i don't consider myself a conspiracy person, but this new war on drugs certainly seems manufactured by politicians to keep themselves employed.

  • Richard A Lawhern PhD||

    There is strong evidence from the CDC itself that our current "opioid crisis" was not created and is not being sustained by physicians over-prescribing to their patients. When State by State rates of opioid prescription are compared to State by State rates of opioid overdose related death, we see no cause and effect relationship at all. The diagram becomes a shotgun pattern with no consistent trend lines. The effects of medically managed opioids are so small that they get lost in the noise of street drugs.

    Moreover, the demographics of chronic pain and opioid abuse are almost entirely disjoint. Seniors over 50 have prescription rates 250% higher than youths and young adults -- but seniors also have the lowest rate of overdose mortality of any age group, a statistic that has been stable for the past 17 years while mortality in youth has skyrocketed.

    Our government is literally chasing the wrong "epidemic", and in the process creating an even worse crisis in under-treatment of pain, doctor desertion and patient abuse.

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