There seems to be no end of mischief that the government can do when it plunges into the quicksand of American medicine. Let’s consider the opioid epidemic. It appears that deaths from opioid overdose have sharply increased in this country. Let’s also grant that this surge in deaths is exactly the way it’s portrayed in both the lay and medical press. Every problem in the US is caused by villains and miscreants. So who are they?
Doctors must head the list. They are said to be massively over prescribing painkillers. They have been sternly admonished to change their prescribing habits by the leaders of American medicine, most of whom do not routinely care for patients with pain. Seventy percent of opioid-induced deaths are from heroin, which is not a prescription drug.
Thus, the obvious solution to a problem mainly secondary to non-prescription drugs is to sue the drug companies. Which, of course, being done by Ohio Attorney General Mike DeWine. He’ll probably win or get a big settlement.
But General DeWine is an ambulance chaser compared to the junior senator from the same state – Rob Portman. Here’s where the old greasy pork barrel gets a major roll. The Republicans want to repeal and replace the Affordable Care Act – aka Obamacare. The bill is stalled in the senate. Senator Portman is a holdout. In order to get him back into the fold the majority leader, Senator McConnell, is said to have offered to add $45 billion dollars to the bill for opioid addiction. In 2015 there were about 33,000 deaths from opioid overdose. That’s about $1.4 million per death. The NIH’s annual budget is about $32 billion. And that’s for every disease known to man and a few others that aren’t.
All of this money for a problem that is self induced. No one forces a heroin addict to take the dangerous drug. An aside, much of this concern for opioid overdose coincides with the legalization of recreational marijuana. Anyway, back to opium and its congeners. Most people who want to spend fantastic sums on its treatment are convinced that drug addiction is a disease. Perhaps it is, but it is very dissimilar to most others, like cancer and heart disease, in that a person afflicted with it can decide all on his own to stop having it. A small, but real, minority do just that every year. Drug addiction is a serious and potentially lethal disorder of behavior, but it doesn’t fit the disease paradigm.
Virtually all the proponents of drug addiction as a disease personally and financially benefit from such a designation. Where will the senate’s $45 billion go? Presumably to treatment programs. They are all over the country. There is still great controversy as to whether they are any better than an admonition to stop taking whatever drug is being abused.
Altering human behavior of any kind is notoriously difficult. Throwing Fafner’s treasure at self destructive behavior, while at the same time scaring doctors into withholding needed narcotics from patients with severe pain, does not seem like a prescription for the effective use of scarce resources.
Senator McConnell’s off the cuff offer of $45 billion, for God knows what, while at the same time ignoring the country’s fixable problems, is an example of why no one trusts congress. Could the majority leader even define addiction? A drug is addicting when its causes habituation, dependence, tolerance, and withdrawal. Using this definition a lot of substances that we commonly call addictive are not, eg tobacco and cocaine. Neither of these is associated with withdrawal, ie seizures, delirium, etc.
Opioid addiction, irrespective of whether it’s a disease or not, is a serious problem. Spending a fortune treating addicts after the fact is likely to have little or no effect. Preventing the problem is a far better approach. The obvious problem is how to do it. The reasons why people become addicts are likely as numerous as that of the addicts themselves.
Deaths from smoking and alcohol abuse are far more common (more than half a million per year) than opioid deaths and are all due to bad behavior. Smoking related deaths are way down mostly because Americans have either stopped smoking or never started. The experience with tobacco suggests how we should proceed with opioids. But recall that there is no safe or medically indicated use of tobacco unlike painkillers. Don’t hold your breath waiting for a reasoned and appropriate solution to a complex problem.