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.”


About Steve Greene
Professor of Political Science at NC State

4 Responses to The opioid epidemic reflects policy choices

  1. Nicole K. says:

    My old neurologist – who primarily specialized in sleep medicine – left his private practice largely because the DEA was hassling him about prescribing large quantities of stimulants (from what he said it was mostly Adderall they were concerned about). The doctor treats sleep disorders like narcolepsy. Do you know what the 1st line treatment for narcolepsy (and many other sleep disorders that cause excessive daytime sleepiness) happens to be? It’s, of course, amphetamines. The amount of paperwork and scrutiny legitimate doctors (especially those in single doctor practices) is staggering.

    I remember the last appointment I had with him. He said he opened his practice to help people. And he finally decided it just wasn’t worth it anymore. He’d rather go work somewhere and collect a paycheck than be harassed for being a sleep doctor who gave people suffering from excessive daytime sleepiness stimulants.

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