In the time that it takes you to read this article, someone will die of an overdose of opioids. Over the course of the day, 115 people will die of one. In 2016, 64 thousand people died of overdosing on prescription pain medications, fentanyl, and heroin. The burden on society from this crisis is enormous. An estimated $78.5 billion is lost on criminal measures, foregone productivity, and healthcare from individuals suffering from this addiction. The opioid crisis requires a solution, but few of the current government policies offer one.
Much like the methods used to fight the War on Drugs, government solutions to the opioid crisis are ill-conceived and heavy-handed. A policy to execute drug dealers as a way to dissuade the selling of drugs and the building of a border wall to stop the flow of illegal drugs from Mexico are just two of the more far-fetched ideas to come out of the Trump administration in recent months. Not only are these methods immoral and prohibitively expensive, they largely miss the point. Supply-side approaches to drug addiction have failed spectacularly when tested, as in the War on Drugs America had lost decades ago, yet still continues to fight. Moreover, a supply-side solution will not work when demand for the product is so inelastic, and those in the grips of drug addiction will pay anything to get their hands on the product. Beyond these two policy ideas and the current status quo, the administration has unfortunately not been successful in articulating how it plans to tackle the opioid crisis. Below are three proposals that, when combined, may make a meaningful dent in how many people are lost to this horrible crisis.
First, and arguably most important, is the recognition that any solution must involve tackling mental health issues as well. A paper from the National Bureau of Economic Research (NBER) has found a definitive link between mental health and substance abuse; mental illness increases the use of cocaine by 27 percent and the consumption of cigarettes by 86 percent. Individuals who suffer from mental illness may find that the use of drugs helps to lessen the emotional and mental pain they feel. Rates of clinical depression have risen over the past decade, especially among the young, and lack of treatment will ensure that these rates keep rising. While the federal government has historically left national mental health trends unaddressed, perhaps because it is too expensive or difficult to tackle the problem, any solution to the opioid crisis must appreciate that some of drug addiction is rooted in mental illness. State and local governments may help to pick up the slack in this area that the federal government has failed to address, through first having an open dialogue about the scourge of mental illness, and then through the funding of mental health clinics and treatments. The fact that nobody is seriously talking about mental health on either a local or national level is hurting America.
The second approach to solving the crisis involves the legalization of drugs, a policy I have advocated for in previous articles. The illegality of synthetic opioids is not simply a moral or ethical issue; it is now an issue of life and death, as illegal synthetics are killing people. Part of the reason so many opioid users die of an overdose is because they buy heroin that is unknowingly laced with fentanyl. Fentanyl is 100 times more potent than morphine, making even very small amounts of it extremely dangerous. Part of why drug dealers can get away with selling fentanyl-laced heroin is that there is no legal market to keep them honest, a problem legalization would solve as nobody would buy from a drug dealer that kills his own customers, and therefore the drug dealer has an incentive to sell safer varieties of opioids. Much like legal markets that force participants to innovate and become better ultimately benefit consumers, so too can the legalization of many opioids help to reduce the death toll of the opioid crisis. While legalization may not strip away the demand for drugs, it can at least ensure that fewer numbers of people die from their consumption.
The third idea to help stem the opioid crisis is one that is already being instituted, but unfortunately, incorrectly. Much has been made of the fact that doctors prescribe a large number of opioids to patients in chronic pain due to a rating system based on how much a patient’s pain was reduced from visiting the doctor. The theory is that doctors are subservient to these ratings, and would rather therefore overprescribe and risk getting the patient addicted than be poorly rated. But the solution to this issue is once again heavy-handed; doctors are being browbeaten to the point where legitimate sufferers of chronic pain cannot get access to their medications. A better solution would be to recognize that only 20 percent of individuals that take prescription opioids go on to abuse them; the majority of legitimate users take opioids responsibly and should not be punished for the actions of a few. To drive this 20 percent figure down, doctors may be taught to prescribe opioids in stages; this means that doctors should require patients to come in for a visit before more opioids can be prescribed. This would solve the current issue of over-prescription without hurting the people that really need the drugs, by prescribing a small number of pills each time and actively monitoring the patient for signs of addiction, which doctors can catch and treat in time. A light-handed approach involving more interaction with trained physicians for the management of chronic pain can help patients to avoid an opioid addiction before it begins, although it is important to remember that chronic pain sufferers are responsible for only a small amount of the current opioid crisis.
Like most issues, the current opioid crisis will not be made better by difficult, expensive, and harsh policies from the government. There are solutions like mental health counseling, drug legalization, and light-touched physician supervision that have the potential to do good and help to end the crisis. This administration will do well to give them a chance.
Jenny Grimberg
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