The crisis will not abate if the real problem is not addressed effectively.
There are good reasons to fear that special interests are pushing us in the wrong direction by targeting deep-pocketed pharmaceutical companies instead of elusive street dealers and foreign drug cartels.
In the “opioid debate/crisis”, the left and right wing differences in this country are blurred and the most support for pain patients is coming from libertarians.
A critical data point was provided by research confirming what police and doctors working on the front lines have said for years: the center of gravity in the opioid epidemic shifted from the overprescription and abuse of prescription painkillers to heroin and deadly fentanyl about a decade ago.
The skeptical position on our current drug war, stated bluntly, is that trial lawyers are eager to bring enormous lawsuits against pharmaceutical companies, and they have more than enough political influence to shape legislation.
Many legislators prefer the narrative of rapacious Big Business getting the American people hooked on pills to reap windfall profits.
I had not thought of this angle, yet it certainly explains why our opioid policy is so very misguided. Money always twists the truth to its own ends.
There is no money to be made by going after drug dealers and street gangs
One element of the opioid crisis is a problem the Washington elite loves to attack, while the other is something it doesn’t want to touch with a ten-foot pole.
It seems reasonable to worry that the establishment will reverse-engineer a diagnosis that justifies the course of treatment it would much rather pursue.
Daniel Horowitz wrote in the fifth installment of his opioid series at Conservative Review that the danger of political misdiagnosis was the primary reason he set pen to paper.
Horowitz charges that the current round of congressional hearings on the drug crisis “feature heads of organizations and programs that stand to benefit from endless taxpayer funds,” while very little attention is paid to the politically awkward and unprofitable problem of drug cartels flooding America’s streets with heroin, fentanyl, and cocaine.
Meanwhile, a legal offensive comparable to the gigantic lawsuits against Big Tobacco is taking shape in the courts, led by some of the same lawyers and firms that went after the tobacco companies.
I’m so sad that our country’s response to almost any crisis these days is to start a lawsuit. As if only money were at stake.
Only money, not lives are reinstated by lawsuits.
“The prospect of the biggest payday since the $200 billion tobacco settlement in 1998 has drawn many of the same plaintiff lawyers who appear again and again in big tort cases over everything from VW diesels to Vioxx to the BP Deepwater Horizon disaster,” Daniel Fisher observed at Forbes in January, as multi-district legislation against opioid manufacturers and distributors gained momentum
Lawsuits against drug companies and distributors allege they have
- deceived the public on a massive scale with advertising for their products,
- flooded markets with opioids,
- pushed doctors to prescribe them, and
- failed to investigate illicit drug orders properly.
The industry responded by accusing litigants of misunderstanding how the distribution system for prescription drugs works and turning pharmaceutical corporations into lucrative scapegoats.
If Congress and the courts get the opioid crisis wrong, patients who truly need medication for chronic pain will suffer even more than they already do.
They already complain that the drugs they need have been excessively stigmatized and doctors have been intimidated out of writing prescriptions.
The patients themselves resent being treated like drug addicts.
They have good reason to fear their access to vitally needed medication will grow even more restricted, between heavy-handed legislation and lawsuits that could clobber drug companies with billions of dollars in damages and settlements.
Insurance companies are in the mix as well, performing calculations of benefit and risk, including legal risk, that can contradict the judgment of physicians.
That’s the problem I see too: payors use their power to maximize their profits.
Unfortunately, this is exactly what large corporations are supposed to do: make money for their shareholders.
My own retirement account invests in a wide range of securities and I’m sure they include some insurance companies and pharmaceuticals.
So, do I want to make money on my investments to pay for my medical treatment or do I want to take a loss because the corporations in which I have a stake (no matter how small) are providing better health benefits to me?
I think this is a problem with unrestrained capitalism in general because all value is measured by money alone and no other “goods” (like social goods) are considered (counted).
Some doctors are worried that severe new limits on prescription opioids proposed by the Center for Medicare and Medicaid will leave chronic pain patients unable to obtain the medications they need.
Doctors who questioned the new limits said they could force patients to seek out more dangerous illegal substances to manage their pain or even drive them to suicide.
“People who are gonna use heroin and fentanyl are gonna go ahead and use it. People who are really dependent on opioids, because there is no access to treatment, they are gonna move on to heroin.
Only the set of people this is going to affect is a lot of people who are stable on this medications,” Yale University addiction medicine fellow Dr. Ajay Manhapra predicted in March.
In early April, officials with the Centers for Disease Control conceded that its 2016 guidelines on opioid prescription might have been based on flawed data.
Not “might have” – they were!
I first found out and posted about this on March 18:
CDC Over-Counting Rx Opioid Overdose Deaths
Specifically, the research supporting the guidelines was criticized for failing to distinguish between overdoses of legally obtained pain medication and deaths resulting from illicit heroin and fentanyl.
None of this is meant to absolve drug companies of all possible misbehavior, argue that prescription drug abuse is no longer a problem at all, or dismiss all funding for addiction treatment as taxpayer money siphoned off by special interests.
The point is that government at every level should examine the opioid crisis clearly and honestly, with the vision of lawmakers as unclouded as possible by big money or political narratives, before regulations are imposed and funds are allocated.
There are already too many examples of people suffering unnecessarily because the problem has been diagnosed incorrectly.
There should be no room in this process for political narratives, hidden agendas, grandstanding, or blind panic.