The opioid epidemic reflects policy choices

So, yesterday in my public policy class, while I was talking about the failure of the “war on drugs” and how we need to treat addiction as a public health problem, not a criminal justice one, in class yesterday, Radley Balko was posting this excellent piece on how bad policy choices contributed to our opioid epidemic:

The other, more important thing to keep in mind is that much of the current crisis is due to a couple of decades of misguided policies that turned a public-health problem into a crime problem. [emphases mine] It began 20 or so years ago when the Drug Enforcement Administration started targeting physicians who specialize in treating long-term chronic pain, essentially ending that area of medicine. The crackdowns made it increasingly difficult for chronic-pain patients to find well-trained, conscientious pain specialists to treat them. Most of the doctors who weren’t arrested migrated to other areas of medicine. Medical students understandably wanted nothing to do with pain management. But the pain patients didn’t go away. That created demand for someone to provide them relief. That demand was filled by far less careful and conscientious doctors — the “pill mills” you often read about. Meanwhile, more-reputable doctors were told to view patients who were dependent on these drugs not as patients who were depending on the medication — just as a diabetic is dependent on insulin — but as addicts.

There’s no question that unscrupulous doctors, pharmacies and pharmaceutical executives have contributed to the current crisis. But bad policy is the real problem. Drug cops aren’t doctors. Yet for some reason, we’ve decided to bring them into the business of deciding what doctors can prescribe to their patients and in what quantities. If physicians are recklessly prescribing these drugs, they should be disciplined by medical boards, not raided by SWAT teams. Treating pain is difficult. It requires care and finesse to both address the suffering of a patient and to keep that patient away from the threat of addiction. Drug cops aren’t known for their care or finesse. They tend to have one gear…

Asking law enforcement to handle prescription drug abuse was a huge mistake in the early 2000s. We don’t seem to have learned much since. The latest surge in opioid-related deaths has pundits and publications across the political spectrum calling for an ever greater law enforcement role in preventing addiction, and for generally more punitiveness across the board. Prosecutors have responded by targeting more doctors, or by bringing murder charges in overdose deaths. Legislatures have followed with new laws such as lowering the minimum weight of illicit drugs needed for felony charges and new mandatory minimum sentences for trafficking or distributing drugs such as hydrocodone, fentanyl or heroin.

That means more felons, more prisons and more lives ruined by incarceration. Addicts get treated as criminals, not as patients in need of treatment. And meanwhile, people living with chronic pain find it ever more difficult to get the medication they need.

When will we ever learn?!  Not by 2017 apparently.  It doesn’t have to be this way.  I’ll leave you with a link and a headline, “Portugal decriminalised drugs 14 years ago – and now hardly anyone dies from overdosing.”

Advertisements

The Republican health care contradiction

Not quite sure what occasioned this from Ezra this week, as much has already said by him and others last month, but it’s a great succinct summary, so I’m going with it, too:

The most interesting policy argument in America right now is the debate between conservatives’ real position on health care and their fake position.

The fake, but popular, position goes something like this: Conservatives think everyone deserves affordable health insurance, but they disagree with Democrats about how to get everyone covered at the best price. This was the language that surrounded Paul Ryan and Donald Trump’s Obamacare alternative — an alternative that crashed and burned when it came clear that it would lead to more people with worse (or no) health insurance and higher medical bills.

Conservatives’ real, but unpopular, position on health care is quite different, and it explains their behavior much better. Their real position is that universal coverage is a philosophically unsound goal, and that blocking Democrats from creating a universal health care system is of overriding importance. To many conservatives, it is not the government’s role to make sure everyone who wants health insurance can get it, and it would be a massive step toward socialism if that changed…

There has not, in recent political memory, been a national Republican leader who actually argued that the American health care consensus was wrong and it was simply not the government’s job to ensure every American could get health insurance…

Republicans need to realize their problem isn’t poor legislative leadership or dissident House conservatives. It’s that they’ve been hiding their real health care position for decades, and so there’s no public support for the bills that actually achieve their goals. Either they need to change what they believe, and move toward the kinds of policies Roy proposes, or they need to begin the hard work of actually persuading the public that not everyone who wants health insurance should be able to get it.

Yep, yep, yep.  Also reminded me of a Chait post a few weeks ago I forgot to blog about:

But in the long run, these policy defects may be overshadowed by the ACA’s great political achievement: popularizing the idea that the government should guarantee health care to its citizens as a right.

This is not a radical idea. Every other advanced democracy arrived at it long ago, and many Americans already subscribed to the notion before Obamacare was ever introduced.

But as the Trumpcare debate illustrated, the ACA grew the constituency for government-provided health care while fostering the American public’s sense of entitlement to affordable insurance.

The GOP anticipated this development, which is why it fought so hard, on so many fronts, to kill the law. When those efforts failed, for short-term political gain, many Republicans chose not to attack Obamacare’s core premise — that the government should facilitate universal access to basic health care — but rather to attack the law for failing to realize that left-wing ideal…

The Republicans didn’t just lose the battle on health care — they lost the war.

%d bloggers like this: