The Danville Register & Bee has a great if sobering article regarding Virginia’s undeclared emergency — namely, the prevalence of opioid addiction in Virginia communities:
According to a public policy brief by Virginia Commonwealth University prepared for the Senate of Virginia, opioid abuse is increasing due to “high levels of prescription opioid drug supply, lack of understanding of the issue among the public and providers” and “limited availability of treatment.”
“I think every community is feeling the effects of overprescribing and opioids,” Oakes said. “It’s not necessarily that they can’t get it from physicians, but they’re maybe getting it from the streets.”
Some people are in recovery for their opioid addiction, but relapse, Oakes said. There are also people taking prescribed opioids, but buying heroin or fentanyl.
Just to give you a taste of the size and scope of the problem, in West Virginia alone, over 780 million (yes, 780,000,000) pills prescribed over the last six years alone. That 432 painkillers for every man, woman, and child in West Virginia alone.
Blame the doctors, you say? What’s cheaper — health care folks can’t afford, or a pill to make the pain go away? If you’re the consumer begging for help in an economy that can’t afford universal health care… you prescribe relief.
Therein lies the problem. Of course prescription pain killers are no substitute for health care, but our broken Medicaid system meshed with an even more onerous Obamacare system creates these gaps… and the folks who fall between the openings in the grates are often chased with a dose of Oxycontin (or hydrocodone) and when that fails?
So ban oxycodone and hydrocodone, you say? Not as easy as that. At the moment, both are Schedule II controlled substances and for a reason — because for their purpose, they work. Oxycodone, for instance, delivers a very stable dosage of pain relief to the patient (think codeine, from where the name is derived) — the entire reason why it was developed in the first place as a substitute for morphine and other opioids (fun fact: it’s about 100 years old now).
Oxycontin — the improvement on oxycodone — delivers that pain relief in a slow, stable rise over the course of 12-24 hours, hence the reason why it has been so popular since it was introduced to the market.
The problem of course is that it has been treated as aspirin or ibuprofen. Neither oxycodone nor hydrocodone are to be treated as lightly. If you really want to dive into how the U.S. Drug Enforcement Administration regulates oxycodone, click here for details. Short version: DEA could reduce the amount of oxycodone that pharmaceuticals are allowed to make…
…but DEA Diversion tried that once, and it’s a $10 billion industry after all:
. . .the industry fought back. Former DEA and Justice Department officials hired by drug companies began pressing for a softer approach. In early 2012, the deputy attorney general summoned the DEA’s diversion chief to an unusual meeting over a case against two major drug companies.
“That meeting was to chastise me for going after industry, and that’s all that meeting was about,” recalled Joseph T. Rannazzisi, who ran the diversion office for a decade before he was removed from his position and retired in 2015.
Rannazzisi vowed after that meeting to continue the campaign. But soon officials at DEA headquarters began delaying and blocking enforcement actions, and the number of cases plummeted, according to on-the-record interviews with five former agency supervisors and internal records obtained by The Washington Post.
That’s right — the Obama-era U.S. Justice Department slowed things down. If you really want to understand why there is an opioid crisis in Appalachia right now? Read the Washington Post article about how the boot was put on the throat of DEA Diversion by higher ups… and you’ll get the idea.
If you want to fix the problem? Let DEA do its job. One small problem though… Congress (Republican-led) decided to step in on behalf of the pharmaceutical industry in 2014…
That summer, lobbying by the pharmaceutical industry intensified on Capitol Hill. Several members of Congress, led by Reps. Tom Marino (R-Pa.) and Marsha Blackburn (R-Tenn.), were proposing a measure that critics said would undercut the DEA’s ability to hold drug distributors accountable.
Four major players lobbied heavily in favor of the legislation, called the Ensuring Patient Access and Effective Drug Enforcement Act. Together, McKesson, AmerisourceBergen, Cardinal and the distributors’ association, the Healthcare Distribution Alliance, spent $13 million lobbying House and Senate members and their staffs on the legislation and other issues between 2014 and 2016, according a Post analysis of lobbying records.
. . .
The legislation passed in 2016. It raises the standard for the diversion office to obtain an immediate suspension order. Now the DEA must show an “immediate” rather than an “imminent” threat to the public, a nearly impossible burden to meet against distributors, according to former DEA supervisors and other critics. They said the new law gives the industry something it has desperately sought: protection from having its drugs locked up with little notice. (emphasis added)
Meanwhile, folks are dying in Appalachia.
Rannazzisi said he views the new relationship as a surrender to industry.
“This idea that they’re going to say, ‘I’m sorry I violated the law, give me another chance and I’ll make it right,’ without having some type of punishment, to me is outrageous,” he said. “Every time I talked to a parent who lost a kid, I’m pretty sure they didn’t want me to say, ‘Oh, give them another chance because corporate America needs another chance.’ ”
…and that’s why the opioid epidemic is an “undeclared” crisis. Sure, we’ll catch grenades and treat the symptoms… but Washington has it within their power to fix the problem — but won’t unless tremendous pressure is brought to bear.
How’s that for the political process?
UPDATE: Wow… this took off a lot more than I expected. Here’s a chart out of the UK Economist that should shock the hell out of you:
In 2015 more than 52,000 Americans died of drug overdoses, according to the Centres for Disease Control and Prevention. That is an average of one death every ten minutes. Approximately 33,000 of these fatal overdoses—nearly two-thirds of them—were from opioids, including prescription painkillers and heroin. Although the absolute death toll from opioids is greatest in big cities like Chicago and Baltimore, the devastation is most concentrated in rural Appalachia, New England and the Midwest (see map). Many of the victims hail from white middle-class suburbs and rural towns.
More here. Think about this, folks — 52,000 Americans died in this epidemic last year.
That is a 9/11 every three weeks.
UPDATE x2: More here from Vox:
To understand just how bad the opioid epidemic has gotten, consider these statistics: Drug overdoses in 2015 were linked to more deaths than car crashes or guns, and in fact killed more people than car crashes and gun homicides combined. Drug overdoses in 2015 also killed more people in the US than HIV/AIDS did during its peak in 1995. So just as HIV/AIDS lives in the American mind as a horrible epidemic, the current opioid epidemic should too.