Lessons from America’s Opioid Crisis

President Trump’s decision to approach America’s opioid crisis as a “national health emergency” is a welcome departure, if only rhetorically, from his country’s decades-long attitude to illegal drugs. Attention to the opioid epidemic is long overdue: between 1999 and 2015 more than 560,000 Americans died from drug overdoses, a number that increases by 175 on a typical day. Routine overuse of prescription drugs has also become entrenched: 100 million Americans currently take medication for chronic pain, 27 million use illicit drugs regularly, according to the US Surgeon General. The recent toll of opioid prescriptions is now well-known but research by the Centers for Disease Control shows that other pain prescription-related fatalities have also been rising. In 2011, nearly a third of deaths caused by overdoses of pain medication were attributed to benzodiazepines, legally available anti-anxiety drugs.

Trump denounced “dangerous criminal cartels [that] have been allowed to infiltrate and spread throughout our nation” but America’s opioid crisis is mostly homegrown. During the 1990s pharmaceutical companies aggressively marketed the use of new drugs to ease chronic pain, even though they knew that they were, at best, a temporary solution that quickly stopped working and often left users addicted. The current crisis is due in large part to misleading claims by big pharmaceutical companies who propagated their wares with the full knowledge that many would end up on black markets or be shared with patients’ friends and associates, producing further addiction. Between 1996 and 2001 the DEA estimates that oxycodone-related deaths in the US quadrupled and OxyContin prescriptions grew twenty-fold – but the companies profiting from this epidemic were generally left alone.

America’s ineffective regulation of irresponsible pharmaceutical companies has been all too predictable. The few high-profile prosecutions that have occurred have been too little, too late. In 2007, the parent company of the manufacturers of OxyContin was fined US$634m for deceptively promoting “a highly abusable, addictive, and potentially dangerous drug on an unsuspecting and unknowing public,” according to the US attorney who prosecuted the case. Since then there have been no settlements of comparable magnitude. Meanwhile the overprescribing continues – last year US doctors prescribed enough pills to fill a bottle for every adult in the country – and drug overdoses have become the leading cause of death for Americans under 50, with an annual toll greater than the lives lost in the Vietnam, Iraq and Afghanistan wars combined.

A 2016 report by the US Surgeon General contains several key insights into America’s evolving approach to drug addiction and suggests ways that the Caribbean might rethink its own antiquated attitudes and policies. Firstly, the report underscores the importance of treating addiction as a medical challenge rather a criminal or moral failing: “Addiction to alcohol or drugs is a chronic but treatable brain disease that requires medical intervention, not moral judgment.” Second, it notes that although there are several effective treatments there remains a significant “treatment gap” (only 10 percent of addicts seek treatment) largely due to the stigmatization of drug use within society – a lingering consequence of the interminable “drugs war” launched by President Nixon in July 1971.

Moving away from a punitive criminal-justice approach to drugs will require a “cultural shift in the way we think about, talk about, look at, and act toward people with substance use disorders,” says the US Surgeon General, but this is achievable. The report notes that “Cancer and HIV used to be surrounded by fear and judgment, now they are regarded by many as simply medical conditions.” Finally, the report emphasizes the “strong scientific as well as moral case for addressing substance use disorders with a public health model” and notes that since such an approach entails “reducing both health and social justice disparities” it also strengthens the economic rationale for a new approach.

Drug addiction in the Caribbean differs significantly – for obvious economic, cultural and political reasons – from that in the United States, but that should not prevent us from absorbing their hard-won insights into the issue, and learning  how to face our own problems with addiction with more intelligence and compassion.

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