Opioid Epidemic at the Start of 2019: Where’s the Progress We Were Promised?
When tens of thousands of your fellow citizens die in one year from the same preventable cause, you rightly call it a “crisis.”
You might not know the opioid epidemic is a proper crisis, though — not with the administrative branch of the government and most of the media manufacturing a different ‘crisis’ on a near-daily basis. Truth be told, we are seeing some progress in turning the tide of this problem. But the progress hasn’t been uniform or consistent, and it definitely hasn’t been because our usual policies of punishing our way out of drug abuse have suddenly started working.
It is true that the Trump administration inherited this problem. We all did to various degrees. But what are we doing to make things better?
A Cause for Optimism?
In October 2018, Alex Azar of Health and Human Services called for a sense of optimism when he stated that “the U.S. may be ‘beginning to turn the tide’ on the opioid crisis.” He continued: “The seemingly relentless trend of rising overdose deaths seems to be finally bending in the right direction […] we are perhaps at the end of the beginning.”
This declaration came sometime after President Trump made the uncontroversial call to label the opioid epidemic a “public health emergency.” It also followed the American Congress’ decision to approve the Support for Patients and Communities Act.
Donald Trump has yet to slap a “mission accomplished” banner on an aircraft carrier and call it a day here. He was right to call this emergency what it is. But are we as close to the finish line as we’d like to be? Or as we should be?
We have data that can help shine a light on some of the nuances of this situation. It can also help us get a handle on which policy proposals have put a dent in the rate at which these drugs are putting our brothers and sisters in the ground before their time. We talk about “crises” on a daily basis now. Is the opioid epidemic a crisis still?
What Does the Data Say About Our Progress — and Our Policies?
The data we’re working from here is recent as of March 2018. What we know is this: Overall opioid overdoses — remember this distinction — may have peaked in 2017 at 72,000, and numbers from early 2018 indicate a drop-off had begun.
You can see this is not a very long period — a little less than half a year — from which to formulate something 100 percent concrete. The situation we’re in now has been worsening for decades. It’s nevertheless a good sign that overall opioid overdoses appear to have reached their zenith.
Here’s the bad news, hidden in the details: The overall downward trend is good, but overdoses from synthetic fentanyl are actually accelerating. These trends appear strongest in areas of the country that are already marked by higher-than-average rates of heroin use and abuse.
In other words, we’re seeing some of our worries coming true when it comes to hardening our prescription laws and tightening the flow of opioids. Experts are not surprised to see rates of heroin and fentanyl holding steady or accelerating. For want of prescription-based opioids — overdoses from which are, again, on the decline — many people are now turning to other illicit substances, like heroin and cocaine, and those they are likely to be mixed with, such as fentanyl.
To put it another way, we’re turning addicts into criminals — instead of into patients.
Are We Seeing Community Health Improve?
When we look at the counties throughout Appalachia and the American Midwest which have been hardest-hit, we see that some counties have had 60 percent drops in ER visits — and/or ambulance usage — throughout one year. The same research indicates some decreases at the county level for general opioid deaths. And the national level? Between April 2017 and April 2018, opioid deaths dropped by 1.1 percent over the same period.
Again, this is good news. But we need more.
At this time, just 12 states allow for the use of Medicaid to fund comprehensive substance abuse treatment — despite our knowing that such programs have had a very positive impact on the opioid epidemic so far. If we’re approaching a drop-off in opioid overdoses, it is also certainly thanks to state-level leadership in getting naloxone antidotes into the hands of more first-responders, police officers and even individual citizens.
The rest of the fight against opioids comes down to, unfortunately, a mountain of prejudice. We’d rather jail addicts than treat them, which is more expensive and doesn’t stop them from using again after they’re released.
We know addiction behaves like a disease, which is why the only people we should be jailing for drug problems are the ones peddling the hard stuff. We know pharmaceutical decision-makers had a fairly good idea for decades that their industrial-grade painkillers and other medications represented a considerable risk of dependency. They continued selling them anyway, just like big tobacco and big oil and big everything else.
There is a lot of accountability to go around. And yes, Donald Trump has, in his own way, paid some lip service to finding solutions. But his proposed solutions pale in comparison to those of his predecessor where human compassion is concerned. Trump has promised to take up the Republican Party’s marching orders to assault Medicare, Medicaid, the ACA, Social Security and nearly every other piece of our social safety net, most of which, as we’ve seen, have a pivotal role to play in ending this calamity.
So long as that’s the case, and so long as the GOP crouches atop Capitol Hill like a vengeful, greedy toad, it makes Trump’s and every other Republican’s “declarations” and tweets and promises about solving this problem more hot air — and no help to any of us.