Is the Opioid Crisis Too Complicated for Our Political Elites?
The United States is experiencing an opioid epidemic affecting more than 2 million Americans. In March of 2018, the National Institute on Drug Abuse (NIDA) reported:
Every day, more than 115 Americans die after overdosing on opioids. The misuse of and addiction to opioids — including prescription pain relievers, heroin, and synthetic opioids such as fentanyl — is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.
Certain facts related to opioid use are undeniable. For instance, the Centers for Disease Control and Prevention states that between June 2016 and June 2017, drug overdoses killed more than 66,000 people in the U.S. Nor is there disagreement among the experts about this fact: America is in the throes of an existential drug crisis.
However, sundry government officials and media elites are coalescing around an accepted — yet wholly inaccurate — narrative about what has triggered the epidemic. The narrative goes like this: Greedy pharmaceutical companies seeking to boost profits in the late 1990s pushed the medical community to over-prescribe opioids while misleading doctors about the fact that patients would become addicted.
Among other things, this narrative neglects how America’s border control policies have impacted opioid abuse and how other factors besides prescription-drug abuse have all exacerbated the crisis, including joblessness, heroin, and fentanyl, and expanding Medicaid access to higher-income earners.
“Everyone,” Daniel Patrick Moynihan liked to say, “is entitled to his own opinion, but not to his own facts.” Unfortunately, as with many policy debates in Washington, D.C., the debate about opioid abuse is obscured by opinions and ideological biases that are being propagandized as facts.
The opioid crisis is complicated. But complicated doesn’t work in newsrooms or on Capitol Hill. It’s far more effective to have a “boogeyman” — some group to blame and from which to extract recompense. To paraphrase the great Roman orator Tacitus: the crowning injustice of political warfare is that all claim credit for success, while defeat is laid to the account of one. In the political fight over what to do about the opioid epidemic, Washington’s political class has decided to charge America’s pharmaceutical industry as guilty.
However, facts must still matter. America’s opioid crisis is the result of many policy and societal failures, with numerous players and factors to blame, including federal agencies such as the Veterans Health Administration (VA), the Center for Medicaid and Medicare Services (CMS), and the Drug Enforcement Administration (DEA). Few Americans realize, for instance, that the DEA sets annual production quotas for opioids. The DEA is the “legal gatekeeper” for America’s opioid market.
Then there is the VA. With a worthy objective to improve pain management for the nation’s veterans, the VA launched the Pain as the 5th Vital Sign program in the early 2000s, requiring health-care providers to ask all patients about their pain levels, given the common assessment that pain was undertreated. This initiative put into practice federal policies that in hindsight failed to implement the proper safety protocols.
Finally, CMS created federal procedures that linked pain management to Medicare reimbursement. This official connection to payment had the unintended consequence of encouraging many physicians to treat normal aches and pains with potent opioids meant to control the high-level pain associated with more serious conditions.
If understanding the root causes of the opioid crisis should inform the policy prescriptions we use to try to fix it, then these facts matter. Instead, what too often characterizes the opioid discussion is the conventional “gotcha” politics — which is good for politicians needing a soundbite or a trial attorney looking for a big payday but bad for those suffering from this crisis. So, for instance, ambitious state attorneys general looking to advance their political careers and fill their state coffers need deep-pocketed scapegoats — cue “Big Pharma.” However, as former Senator Tom Colburn has stated, many of these politicians are “attempting to replicate the success of the coalition of state attorneys general who successfully sued ‘Big Tobacco’ in the 1990s” by filing lawsuits against pharmaceutical companies that make opioid pain killers. Treating pharmaceutical companies like the tobacco industry of yesteryear does nothing to advance medical progress or to alleviate the epidemic of opioid abuse.
The great irony here is that government officials are suing pharmaceutical companies over a health-care crisis that government officials helped create. Meanwhile, many of these same politicians are refusing to have honest — and more difficult — policy discussions over important, albeit provocative, issues such as how lapsed border control and Medicaid expansion are serving to fuel the opioid crisis.
Take border control. Earlier this week, two former agents with the DEA who fought Pablo Escobar — Javier Peña and Steve Murphy — were on Capitol Hill testifying about how America’s porous border is a key factor in America’s drug crisis. They pointed out how drug dealers are now targeting American patients — particularly patients suffering from cancer. There are enormous amounts of counterfeit fentanyl and other counterfeit medications flooding across our southern border.
In spite of these facts on the ground, many in D.C. refuse even to discuss funding a wall as part of an overall strategy to strengthen border control and combat some of the forces that are contributing to the opioid emergency. In the 2019 budget plan released earlier this year, the Trump administration refers to the wall as a key component of such a strategy: “The Administration is seeking the total $18 billion request for the border wall. Building the wall is critical to impeding and denying the flow of illicit drugs into our country.”
President Trump has now declared the nation’s opioid crisis a “public health emergency.” To effectively deal with this emergency many in the political class must move past their ideological preferences. The opioid crisis is the result of myriad actors and failures; no one group or factor is to blame. Instead of assigning blame, let’s start building a national consensus on how to save millions of our neighbors, friends, and fellow citizens.
Jerry Rogers is the founder of Capitol Allies. He was a deputy vice president at the Pharmaceutical Research and Manufacturers of America from 2003–2008