Wednesday, April 18, 2018

Here's Why Trump's Solution to the Opioid Epidemic is Foolish, Cruel and Bound to Fail

by Nomad

"This Horrible, Horrible Situation"

President Trump has never shied away from talking about the opioid epidemic. In October, he declared it to be a national public health emergency under federal law. He said:
No part of our society — not young or old, rich or poor, urban or rural — has been spared this plague of drug addiction and this horrible, horrible situation that’s taken place with opioids.
Moreover, he committed his administration to finding a solution. He vowed to "spend money" and- like magic- the numbers of drug users would "tumble." In his State of the Union, Trump spoke of his administration's commitment to "fighting the drug epidemic and helping get treatment for those in need.”

His critics noted, however, that since that time, Trump has offered no significant policy initiatives and allocated no new resources. Yet, he continued to talk about the issue.
And talk.
In March, the president made news when he suggested using the death penalty on drug dealers to address the opioid crisis. Trump said a speech in New Hampshire:
"We have pushers and drugs dealers, they are killing hundreds and hundreds of people. You shoot one person, they give you life, they give you the death penalty. These people can kill 2,000, 3,000 people and nothing happens to them."
Trump cited Singapore's zero-tolerance policy, and, more disturbingly, the policies of Philippine President Rodrigo Duterte.
The controversial leader gave police the authority to execute drug peddlers — Duterte has even admitted to personally killing criminal suspects — but the matter has morphed into a human rights situation amid widespread reports of extrajudicial killings.
Apart from that, there were other problems with Trump's plan. Experts pointed out that targeting dealers is, at best, a flawed approach because "a very high percentage of people who sell drugs do it to support their own habit.”

Other sources note that Trump's action plan fails on other levels too.
Trump’s focus on punishing drug dealers with death shifts the blame for the epidemic onto desperate, powerless, and often addicted individuals and away from licensed drug dealers who are arguably much more responsible for thousands of deaths.

Who Knew the Opioid Epidemic Could Be So Complicated?

There's no question that the opioid epidemic is an extremely complex problem. Complex and devastating.
As one source tells us:
In 2016, the latest year with a full official count, there were nearly 64,000 drug overdose deaths in the US — an all-time high. The rise in drug overdose deaths was a big reason that life expectancy fell for the second year in a row in the US, which had not happened since the early 1960s.

And the early data suggests that 2017 was worse: According to preliminary figures from the Centers for Disease Control and Prevention, there were nearly 67,000 drug overdose deaths in the 12-month period through June 2017, up from more than 57,000 in the 12-month period through June 2016.
As we have seen, Trump has a limited capacity to deal with complex problems. It is much easier to talk about building walls and executing drug addicts-turned-dealers.

Another facet of the problem is that over-prescribed painkillers, such as oxycodone and hydrocodone, have become gateway drugs for black market drugs. This opens the door to counterfeit versions or heroin — which often carry far greater hazards.

As far back as 2010, studies showed that the vast majority of opioid addicts began their descent with legally-prescribed painkillers.
University at Buffalo researchers interviewed 75 patients hospitalized for opioid detoxification and found that 31 of them said they first became addicted to legitimately prescribed painkillers.
Another 24 patients said their addiction began when they used a friend's left-over prescription pills or stole drugs from a parent's medicine cabinet, while the remaining 20 patients said they got hooked on street drugs.
The original sources might have varied but the outcome was the same.
But the study found that 92% of the patients said they eventually bought illegal drugs (usually heroin) because street drugs are less expensive and more effective than prescription drugs.
Until lawmakers stand up to pharma companies that push doctors to over-prescribe highly addictive painkillers, the epidemic of illegally-sold opioids will continue to plague communities.

Exploration of the Nightmare

To understand the full extent of the problem- and to understand why Trump's so-called solutions are doomed- I have found an interesting (and appalling) reports from MSNBC's Jacob Soboroff.
In fact, the series was first broadcast in June 2017 and, sadly, the situation has not improved since then.

Part One deals with the horrific impact the epidemic has had on America's heartland. In particular, Ohio has become ground zero against this merciless threat. 

Part Two of Soboroff's report, One Nation, Overdosed deals with the failed efforts of law enforcement to deal with the crisis.
At all levels, from local police to federal agencies to border control, this epidemic- the worst in America's history- has overwhelmed all attempts at resolving or managing the problem.

Meanwhile, as Trump becomes more and more distracted by such things as attacks on Amazon, space cadet schools, and porn-star sex allegations, his vow to end the blight of opioid abuse in America is looking more of another promise he won't be keeping.

100 Times Worse 

What Soboroff discovered almost a year ago in his report- that synthetic opioids like fentanyl could be easily ordered online- remains unaddressed by the Trump administration. 
Meanwhile, the problem is about to become much worse.

According to a New York Times op-ed last week, Richard A. Friedman, the director of the psychopharmacology clinic at the Weill Cornell Medical College, drugs 100 times more potent than fentanyl are now available through Chinese distributors.
And it is as easy as ordering a pizza.  

Friedman found that, for a relatively small price, he could buy the highly addictive, and highly dangerous Carfentanil. That's a drug typically used to sedate large animals, like elephants.
Fentanyl is scary enough. A dose of two milligrams — a few grains of the substance — can be fatal. But with carfentanil, 0.02 milligrams — hardly more than a speck of dust — could be enough to kill a person. That means that for $750, I could in theory purchase enough carfentanil for five million fatal overdoses.
If his concerns are justified, then fentanyl in Ohio was just the trial run, the leading edge of the synthetic opioid epidemic.
Although synthetic opioids are relatively easy to make in back-alley labs, a majority of them are coming illegally into the United States from China, where the chemical and pharmaceutical industries are poorly regulated.
Instead of childish spats over trade and tariffs, Trump might have considered an emergency summit with Chinese leaders to offer approved guidelines for pharmaceuticals doing business in the US.
That kind of cooperative approach never seems to have crossed Trump's mind.

Ironically, despite the threat to the average Americans posed by unpoliced Chinese pharma industries, Trump would apparently rather see American addicts-turned-drug dealers on death row.