The number of opioid overdoses in the United States soared by nearly 30 percent last year, according to new data released Tuesday by the Centers for Disease Control and Prevention. But while the Trump administration’s response to the opioid epidemic has largely focused on curbing access to prescription painkillers, the CDC report indicates that the spike in overdoses is likely being driven by heroin and illicit fentanyl.
The CDC looked at emergency room visits and hospital billing data on opioid-involved overdoses from July 2016 to September 2017 in 45 states. The report indicates the problem is getting worse in major cities and in a handful of states, mostly in the Midwest, where overdoses skyrocketed by nearly 70 percent. Not all of the incidents were fatal, and the CDC found that “people who have had an overdose are more likely to have another.”
The report doesn’t devote much space to the underlying cause of the overdose problem, but the CDC authors do note that the dramatic increase is “possibly related to the wide variation in the availability and potency of illicit drug products (e.g., fentanyl sold as or mixed into heroin) that increase overdose risk and drive increases in mortality.”
That finding is starkly at odds with how the government — including the CDC itself — has tried to combat the opioid crisis thus far, by cracking down on doctors who prescribe opioids and making it much harder for people get access to pain medications.
Last week, Attorney General Jeff Sessions announced the creation of a “Prescription Interdiction and Litigation Task Force,” which will “focus on targeting opioid manufacturers and distributors who have contributed to the epidemic.” Last summer, Sessions launched an “Opioid Fraud and Abuse Detection Unit” within the Department of Justice, assigning 12 prosecutors to “focus solely on investigating and prosecuting healthcare fraud related to prescription opioids.”
Meanwhile, the CDC has tightened guidelines for primary care doctors prescribing opioids for chronic pain, and the government is currently mulling a policy change that would further restrict access to opioids for people on Medicare.
There’s ample evidence to suggest that increased access to prescription opioids in the late 1990s and early 2000s contributed to the current crisis, but the latest federal data shows how the landscape has shifted in recent years. Most people who start misusing prescription pills didn’t have the medication prescribed to them, and more people are turning to cheaper, more dangerous street drugs like heroin. Opioid prescribing rates peaked in 2010 and have fallen steadily since, but heroin overdose rates have quadrupled since 2010, and ODs linked to fentanyl and other synthetic opioids like fentanyl increased 72 percent from 2014 to 2015.
The implication is that the crackdown on prescription painkillers hasn’t stopped people from using opioids. If anything, it’s driving users to the black market, where drugs are increasingly tainted with fentanyl and the elephant tranquilizer carfentanil, which are both several orders of magnitude stronger than heroin.
At the same time, pain patients and the doctors who treat them are pleading for relief. They have also warned that tight restrictions on prescription pills could be driving legitimate pain patients to turn to heroin and fentanyl.
The recent CDC report includes some sensible recommendations to address the overdose problem, including expanded access to the overdose reversal drug naloxone, an embrace of harm reduction programs such as needle exchanges, and increased availability of medication-assisted treatments such as methadone and suboxone.
It seems unlikely, however, that the Trump administration will actually implement any of those ideas. The White House’s answer to the opioid crisis thus far has been limited funding and a return to the failed “just say no” campaign from the Reagan era. The Justice Department has indicted two suspected fentanyl kingpins, but the Chinese government refuses to arrest them. Trump himself has expressed a desire to execute drug dealers, but if the new CDC report tells us anything it’s that the opioid crisis has already caused enough deaths.
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