2018 in review: How we debated the opioid crisis
As 2018 comes to a close, the 360 looks back at the stories and issues we debated this year.
The news year in review
It’s been a two-decade, slow-burning misery for many who have been gripped by the opioid epidemic in the U.S., and in 2018 the country saw hope and disappointment while battling the crisis. Opioids, both prescription medications and street drugs like heroin, have been the leading cause of accidental deaths in the U.S. for several years and killed more than 70,000 people in 2017 — more than any year on record, according to numbers from the CDC that were released in December. Overdose deaths were so high that they contributed to a decrease in overall life expectancy in the U.S. for the third year in a row, dropping the average from 78.7 years old in 2016 to 78.6 years in 2017.
There have been glimmers of hope, though: More federal funding than ever before was released to combat the crisis in 2018, and fentanyl, a synthetic opioid that was deemed the deadliest drug in the U.S. this year, has been regulated for the first time as a controlled substance in China, where much of the drug is produced before being smuggled into the U.S. President Trump called the move a potential “game changer” in the fight to revert the crisis. And, local governments across the country have worked with their own resources, often alongside federal funding, to spur positive improvements in their communities.
First responders saved countless lives in the U.S. while armed with naloxone, the opioid overdose reversal drug that has become more readily available in community settings. Many police departments across the country have redefined their roles in the community by creating programs that will help addicts get treatment rather than just making arrests. Treatment centers have also partnered with law enforcement to help get people care immediately, rather than in days or weeks that could cost them their lives.
On the legislative front, in early October, the Senate passed a sweeping bill by a 98-1 vote that committed $8.5 billion this year for opioid-related programs. On Oct. 24, Trump signed the bipartisan bill, which brought together multiple smaller proposals to address prevention, treatment and recovery. The intention of the bill is to increase research into nonaddictive pain therapies, help hospitals manage pain with alternatives to opioids in emergency departments, improve strategies for neonatal abstinence syndrome, promote pain care education and awareness programs, and expand the use of telehealth services to treat substance use disorders.
“I think part of why it passed in a bipartisan fashion is because everybody sees the need back at home,” Trump adviser Kellyanne Conway said during the Yahoo Finance All Markets Summit on Nov. 13. “Whether you represent a state or a congressional district, you just see the need back at home. Law enforcement, access to treatment. Certainly, education and prevention.”
Still, while many agree that the signing of such a bill, the first of its kind, is a step in the right direction, there is still much to be done.
“We’ve created whole communities, generations of families, who have become accustomed to reaching for prescription opioids for any type of pain or just for pleasure,” Dr. Deni Carise, a clinical psychologist and chief scientific officer for Recovery Centers of America, told Yahoo News. Any positive change on a large scale will take time.
Recapping the Perspectives
Federal drug law enforcement deserves a large share of the blame for the crisis. “The Drug Enforcement Administration, the agency that most directly oversees access to opioids, deserves much of the blame for these [opioid-related] deaths,” wrote Leo Beletsky and Jeremiah Goulka in August for the
New York Times. “Because of its incompetence, the opioid crisis has gone from bad to worse. The solution: overhauling the agency, or even getting rid of it entirely.”
Many experts agree, suggesting that the Nixon-designed agency that focuses on the “war on drugs” has been, at best, ineffective and has, at worst, fueled generation after generation of addicts. A “tough on crime” approach is opposite to the medical intervention approach that many experts argue is needed to combat the crisis.
Decriminalizing drug use can lead to progress. Substance-abuse experts have encouraged the government to take a public health approach to the opioid epidemic by decriminalizing drug use and paving the way for addicts to more easily gain proper access to rehabilitation. And some point to the success of this tactic in Portugal, which in the 1990s enforced stringent anti-drug laws with tough prison sentences. When that did nothing to decrease the country’s rampant addiction crisis, it took the drastic step in 2001 of decriminalizing all drug use. Seventeen years later, as reported in a
Time magazine feature on Portugal’s success, the country’s drug-induced death rate is now five times lower than the average in the EU.
But only if we are able to regulate effectively. German Lopez, a senior correspondent at
Vox, writes that while he once supported legalizing drugs, the severity of the opioid crisis has changed his mind:
“We are in the middle of an opioid epidemic, the deadliest drug overdose crisis in US history. This, one would think, would be the most obvious time for the government to step up its regulation of drugs and especially opioids. Yet the FDA, despite having the powers to do so, essentially took no action to regulate what was fairly clear misuse of one of the most potent opioids on the market. In fact, the federal agency essentially folded to the industry — giving drug companies power in deciding how their product should be used and regulated.
“As I’ve written before, I used to support legalizing all drugs. The opioid epidemic changed my mind on the issue — by showing me that maybe my vision of sensible drug regulation in a world where everything from marijuana to heroin was legalized was not based in reality.”
Want to get clean? Treat the opioid crisis like an ecological disaster. In November, Maia Dolphin-Krute of
Stat News argued that government officials should pivot their mindset to deal with the opioid crisis the way they would an ecological disaster.
“Treating the opioid epidemic as an ecological disaster could set important precedents for cleanup and prevention that can be particularly useful in areas where effective responses have been lagging,” she wrote. “The dual nature of opioids as licit medications and illicit street drugs makes ‘cleanup’ a challenge. … [But] containment is still possible for the opioid disaster.”
She writes, “In the litigation against BP after the Deepwater Horizon oil spill, for example, we saw corporate accountability. Although steps toward corporate accountability for the opioid disaster are now underway in some states, where litigation is being pursued against opioid manufacturers, we should support a broader understanding of accountability, one that holds drug makers responsible for developing new, non-opioid treatments for acute and chronic pain.”
State efforts are outpacing federal solutions. Rather than wait for the federal government to act, 2018 saw more and more local community efforts step up to combat the crisis, with towns and cities throughout the U.S. creating innovative solutions to assist locals in getting clean and and in recovery.
In August, the
New York Times editorial board highlighted areas where overdose deaths are decreasing. “The successes on these fronts can be attributed in part to efforts to boost rates of insured individuals — people who are dependent on drugs often struggle financially and cannot afford treatment without health coverage. Massachusetts and Vermont, where overdose deaths are falling, have expanded Medicaid under the Affordable Care Act and have helped people sign up for private insurance. In 2016, just 2.5 percent of people in Massachusetts were uninsured and only 3.7 percent lacked health insurance in Vermont, compared with 8.6 percent for the country as a whole.”
Michael Bloomberg wrote an op-ed for
USA Today that called out the federal government for not acting with the urgency the crisis required. He said that while Trump’s signing of the bill was important, a proper strategy and implementation plan was still lacking. Because of this, he announced that Bloomberg Philanthropies was committing $50 million to help up to 10 of the states hardest hit by the epidemic.
We only beat this with frank, open dialogue. Along with local governments and philanthropists ramping up efforts, a more open dialogue about addiction helped to fight stigma and guide addicts to treatment in 2018. From celebrities revealing their struggles, including Jamie Lee Curtis who wrote an op-ed recounting her decade-long addiction to opioids, and ordinary Americans speaking out about the loss of family and friends to heroin and prescription pills, a more open conversation than ever before now exists.
What happens next?
Experts agree that there is no easy fix to the crisis and that any strategy and initiative will need time to begin any sort of course correction. Despite the positive changes seen in many communities, the crackdown on Big Pharma and on doctors prescribing pain pills, patients with chronic pain, along with their doctors, have found themselves caught in the middle.
More than two dozen states have now implemented policies to limit opioid prescriptions. But the mounting pressure to decrease access and use have left patients like Shannon Hubbard, who has regularly taken opioids for years because of a severe ankle injury, without their usual medications. Hubbard is caught in the middle of Arizona’s new opioid law, which places restrictions on prescribing and limits the maximum dose for most patients.
“They didn’t indicate there was any medical reason for cutting me back,” Hubbard, whose dose was lowered from 100 morphine milligram equivalents (MME) to 90 daily, told Kaiser Health News. “It was simply because of the pressure of the opioid rules.” Hubbard said her pain is “terrible” now.
As Bloomberg noted, “Solving this crisis will not be easy. … And with so many communities crying out for leadership, there is no time to waste.”
