The opioid epidemic

Treating people addicted to drugs as criminals, rather than people in need of medical treatment, is unlikely to stem the opiod crisis in America. “Treating it as a crime is the worst thing you can do,” says Scott Weiner at the Brigham and Women’s Hospital in Boston. “If we start to recognise it as the disease that it is, we can treat it and get people back on track. If you criminalise it, you take away a person’s chance of a normal life.”

But in November the Drug Enforcement Administration (DEA) moved to classify illicit versions of fentanyl as a schedule 1 drug – ranking it alongside heroin. The fact is that the people most likely to be arrested for possessing it are those most in need of medical treatment. Most law enforcement tends to go after the user rather than the importer or distributor. It ends up being ineffective, because it picks up people who are sick.

Some progress was made in the US under the Obama administration, with the creation of new prescribing guidelines for doctors. Since then, many states have set their own prescribing limits, and prescriptions of opioids have reduced by between 12 and 19 per cent since 2012.

Problem: as the legal supply of opioids has shrunk, people have turned to illicit alternatives like heroin and synthetic drugs like fentanyl and carfentanyl. “The number of prescribed opioids is declining, but overdose deaths have been rising,” says Scott Weiner. “It represents the shift from prescribed opioids to illicit opioids”. These drugs are more potent, so are easier to accidentally overdose on. Fentanyl is 100 times more potent than morphine, and carfentanyl is 100 times mote potent than fentanyl. They are thought to be responsible for the majority of accidental overdose deaths in the US.

In December, the Trump administration expanded access to naloxone and began funding development of new pain treatments. Aside from this barely anything new has been done since the emergency was declared.

More success has been accomplished at state and local levels. In New York City, 100,000 naloxone kits, are being distributed, mainly to people living with others at risk of overdosing, and a new program is targetting people who are in emergency care after a non-fatal overdose. These people are offered support and counselling for three months, along with a supply of naloxone. This idea should be adopted throughout the country.

Researchers are working on new treatments for overdose and addiction, and also on ways to develop opioid drugs without the risk of addiction or overdose. One approach is to make drug formulations that are harder to abuse. In the past, some opioids have been crushed and snorted as a powder for a more powerful hit. Newer formulations turn to gel when crushed.
All of this shows that there are ways of tackling the US opioid crisis. But they require money and evidence-based treatments, not sound bites and law enforcement. “As Americans, we cannot allow this to continue,” said Trump as he announced the emergency in October. More than three months later, he is still allowing just that.(New Scientist, Jessica Hamzelou,
3 February 2017)

In 2016, the annual overdose death count reached nearly 64,000, more than three times as many as in 1999. It surpassed the number of fatalities from automobile crashes and homicides, becoming the No.1 cause of death among Americans 50 and younger.

In 2017 14 states saw declines in the number of desths, but aside from that there are few signs of relief ahead.

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