The opioid crisis continues to spiral out of control, and now we have reached a point in the U.S. in which the leading cause of death for people under 50 in our country is from opiate overdose. That statistic is just insane, and should certainly strike a chord of fear in your heart if you were unaware of the depth of the problem thus far.
The government has attempted to address this crisis and respond, but how effective has that response been so far?
The Nation says that “Only a handful of their proposals have been adopted, the 90-day public-health emergency was squandered, and the crisis is wildly underfunded. The only place where Trump has excelled is in elevating stigmatizing views that drug dependency is a moral failing, and that tough-on-crime policies are the only solution.”
To some extent we have a couple of different populations, depending on how you want to segment things. You have the unsuspecting person who is educated, not living in poverty, and happens to get injured or sick and needs to take pain medication for some medical reason. Out of every person who inadvertently has to take pain medicine, a certain percentage will go on to develop some level of dependence or addiction. Furthermore, out of all of those people in this population who get addicted to prescription painkillers while not really looking to “get high and party” by doing so, a certain percentage will eventually turn to the black market to buy illicit opiates or even heroin eventually. This is why treatment centers are collecting data about how every opiate addiction began, interested to see if it started out as a prescription or not. The world (and the U.S.) is currently collecting that data every day now and tabulating just how much of the opiate crisis is being driven by prescriptions, versus how much of it is simply illicit drug use or “partying.”
So these are the two populations that we are dealing with, and sometimes they cross over: Someone with a seemingly “normal life” who suddenly finds themselves liking their Vicodin prescription a little too much, versus someone who is a product of poverty and a system that is stacked against them who seeks out a buzz any way that they can find it, and eventually discovers opiate addiction.
When the politicians are discussing the crisis, it is interesting to see which population they are targeting in their comments, and who they actually want to help. It could be argued that certain politicians want to see harsh punishments for people in one population, but that they still wish to make it sound as if they are trying to create solutions for the other population.
Unfortunately there are so many layers to the problem, and to the solution, that it is almost impossible to see a clear path forward that would be optimal for everyone involved. We could focus our efforts heavily on prevention, on MAT research (medications such as Suboxone or Methadone), or simply promote inpatient treatment as the main solution. But nobody knows exactly what the best path forward is and unfortunately all of the solutions seem to require an awful lot of funding. Treatment is not cheap, and there really is no magic bullet.
One of the hopes has been that MAT, or medication assisted treatment, would be able to “fix” the problem for many people. The truth is that, while MAT is certainly a helpful solution for some, it is really just a quick band-aid for people who are not yet willing to fully surrender and do the work just yet. In other words, if you took a look at all of the people in the U.S. who are struggling with opiate addiction today, maybe something like 5 or 10 percent of them would actually do well and stay clean while using MAT. That is just a subjective guess on my part and not based on any real studies or anything, but I am basing that subjective guess on a population of real people who I have observed in my own line of work. Many, many people who are interested in MAT or (specifically) Suboxone end up relapsing and coming back to treatment again at a later time. What initially looked like it might be a magic bullet has really only exposed who is serious about recovery and who is not.
Some people have suggested that in order to fix the opioid crisis that we have to address and fix the emotional component that is driving people today to want to medicate their emotions in the first place. Unfortunately this is much more difficult in practice than it is in theory. How exactly do we “fix” people who want to escape reality and self medicate? How do we cure an addiction before it begins? How do we convince people to defer their pleasure until later so that they can live a higher quality of life? I don’t believe that you can just tack this on as an extra hour of schooling each week at the middle school level and have it make any kind of real impact.
In other words, the solution ultimately is probably going to have to be multi-pronged and, therefore, expensive. But if we want to really help people then this is where the investment needs to be made right now, as this is the major source of pain and suffering that we are experiencing right now. Inpatient treatment is ideal, but it is not necessarily a cheap solution at scale for everyone who is struggling. Also, keep in mind that treatment often works eventually, but it can take multiple tries sometimes before an addict finally “gets it.”
What do you think of the current opioid crisis? Do you think that politicians are doing enough to combat it?