Targeting One of America’s Deadliest Foes: Opioids

| Michael Vigil
Michael Vigil
Former Chief of International Operations, DEA

Americans are facing one of their deadliest foes in recent history: not ISIS, but opioids, painkillers that are highly addictive and killing thousands of Americans annually. Drug overdoses took the lives of 64,000 people in 2016, with two-thirds related to opioids.

Congress has taken a good first step, providing the federal government an additional $3.3 billion to fight the opioid crisis in its fiscal year 2018 spending bill with a focus on public health efforts. Most of the money, $1.4 billion, will go to the Substance Abuse and Mental Health Services Administration for a new State Opioid Response Grant program and also for the Mental Health Block Grant, according to Vox. The second highest chunk of funding, $500 million, is for the National Institutes of Health for more opioid addiction research.

But federal government efforts have been scattershot, and will not defeat this massive epidemic. It is difficult to understand that the amount of funding will overcome such a massive epidemic when one considers that the U.S. spends $32 billion annually for other illnesses like HIV. Much more money will be needed for treatment, especially opioid addiction medications such as methadone and buprenorphine.  According to a 2016 report by the surgeon general, about 10 percent of people in the U.S. who have a drug use disorder get specialty treatment. Even when treatment is available, fewer than half of the facilities offer opioid addiction medications.

Individual states must develop a strategy that is tailor-made to deal with the particular issues facing their respective area. Law enforcement, health care providers, and other stakeholders should be included in the development of an effective and comprehensive plan to deal with opioid abuse, or we will risk losing as many Americans every year to opioids as we lost in the Vietnam War.

Insatiable Appetite

The United States, at roughly 327 million people, has 5 percent of the world’s population, but is currently consuming approximately 80 percent of the global opioid supply. If one takes into consideration Canada and Western Europe, the figure then climbs to 95 percent.

The opioid epidemic in the U.S. reveals a complex and large-scale threat to our country and its citizens. In 2015, slightly over 300 million prescriptions were issued, making opioids the second largest pharmaceutical class of drugs with cancer medicines being first. Opioid prescriptions are normally used to treat severe trauma and illnesses such as cancer, burns, surgery, and terminal diseases.

The Drug Enforcement Administration in 2014 reclassified one of the opioids known as hydrocodone from a schedule III to a schedule II because of the high risk for abuse. The U.S. now consumes 99 percent of hydrocodone produced globally. It is estimated that in 2014 over 30,000 individuals died from opioid overdoses and half of them to prescription opioids. Every day, 91 Americans die from an opioid overdose, which includes both prescription opioids such as oxycodone, hydrocodone, codeine, fentanyl, morphine and also heroin that is illegal and has no medical use.

Also alarming is the fact that 99 percent of physicians exceed the recommended three-day dosage limit, with a quarter of them providing prescriptions for an entire month. Other factors contributing to opioid abuse include pharmaceutical company payments to doctors to push opioids, marketing by manufacturers downplaying the risk of addiction, and patients not being advised of side effects by their physicians.

The number of prescription opioids sold in 2010 was four times the number sold in 1999. Prescription opioids can also be a gateway to heroin use. A recent survey revealed that 80 percent of Americans who recently started using heroin initially began with opioids for nonmedical reasons. In a 2014 study, West Virginia, New Mexico, Kentucky, New Hampshire and Ohio were the five states with the highest number of recorded drug overdose deaths. Opioids were the principal cause for most of the fatalities.

Compounding the problem is that China is currently producing 85 percent of the world’s synthetic opioids such as fentanyl and carfentanil. Significant amounts are finding their way into the U.S. market through the use of the postal service.

An integrated strategy, encompassing tighter federal regulation and extending to state-by-state action, is needed to make opioids harder to get – and to help those already caught in the cycle of abuse.  Although some of the below listed measures have been undertaken by many states, they need to be implemented by each and every one:

  • Integrate information from state prescription drug monitoring programs into electronic health records and require that opioid prescribers comply with this mandate.
  • Require that physicians and all other opioid prescribers receive training on prescribing and addiction throughout their careers.
  • Develop and promote alternatives to opioid painkillers.
  • Each state should develop a communications plan to raise awareness about the risks of opioid abuse, including integrating drug abuse education in schools.
  • Due to identity theft, pharmacies should be required to check photo identification of patients when picking up opioid prescriptions.
  • States should enact legislation prohibiting physicians and healthcare providers from prescribing more than a 3-day supply of opioids at a time.
  • Congress should pass legislation requiring manufacturers of Schedule II and III controlled substances to participate in a program to collect and dispose of unwanted drugs. They must also participate in outreach and educational programs and pay the associated costs.
  • Laws should be enacted requiring dispensers to report and review patient and dispensing data when prescribing drugs having the high potential for abuse using the Prescription Drug Monitoring Program.
  • The Department of Health Services in each state should certify clinics and programs treating opioid addiction with the use of narcotics such as methadone.
  • States should make naloxone an opioid antagonist, readily available to counteract overdoses until medical care can be provided.
  • Treatment for opioid addiction should also be included in the overall strategy. A key component would be follow-up care to prevent patients from relapsing once they leave treatment.

In order to overcome the opioid epidemic, we must do away with the decades-old view that addiction is a moral failure, and treat it instead as real medical problem.  We will also require a massive public investment to address the huge health care and socioeconomic needs facing millions of Americans.

The Author is Michael Vigil

Mike Vigil is the former Chief of International Operations for the Drug Enforcement Administration. He is one of the most highly decorated agents within the agency and was responsible for numerous multi-national operations, the largest involved 36 countries. He was also responsible for developing global intelligence sharing platforms. He is the author of Read More

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4 Replies to “Targeting One of America’s Deadliest Foes: Opioids”
  1. Thank you for writing such a well thought out and comprehensive article. As the mother of a recovering addict, and someone who works in this space in my career, it is very much appreciated.

  2. Isn’t fentenal what’s actually the primary killer? 99% of deaths fentenalrelated? Isn’t already showing up in cocaine? How long before it appears in pot, alcohol, OTC drugs? Do we ban all substances from tobacco and aspirin or target limited resources on the killer.
    Chronic pain is very well treated by legitimate d

  3. This article puts most of the blame on doctors, instead of the cartels and Chinese who are selling the fake pills and heroin laced with fentanyl and carfentanyl.

    Until 1914, all drugs in the US were legal, and addiction rates were lower than they are now. What addicts there were, generally functioned well in society, since they did not have to prostitute or steal to get their drugs – heroin was available without a prescription at the pharmacy.

    Not advocating drug use, but the root of the problem is that both the cartels and DEA make their money because of the prohibition.

  4. we should legalize all these drugs to bring these people in from the old, and establish a form of supervised ingestion and short term followup

    This will likely reduce these deaths, and undo the criminal profitability of the enterprise, and to the extent that the problem is criminality, unload the courts prison police morgues and crime-turf wars and will de-fund Mexico, itself a valid standalone goal, and maybe add to the public fisc, eg MJ sales

    Most of these proposals harm valid pain med users, like gun control, going after lawful owners and skipping over lawless users

    People want to get high and people want pain surcease, physical or mental, we are not going to change that

    Like needle exchange, the goal or interim, is ‘harm reduction’

    To the extent that there are criminal MDs, the existing systems should catch them

    Interdiction of illegal supply, is essentially not possible