Communist Party USA
The opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain, and the rising toll of harms related to opioid use. —Report from the National Academies of Sciences, Engineering, and Medicine, 2017 Decriminalization is important, because it introduces a lot of coherence in the system. If you address the problem as a health condition, it makes little sense to criminalize this kind of behavior. . . . You don’t criminalize a diabetic because he eats too much sugar, or a cigarette smoker. Even with what can be considered a self-inflicted disease, the state assumes the responsibility to contribute to a better life of its citizens. —João Goulão, MD, architect of Portuguese drug policy and Director-General of the Service for Intervention on Addictive Behaviours and Dependencies, Ministry of Health Beneath the COVID-19 pandemic lies the ongoing and worsening crisis of opioid overdose and death. Data from the Centers for Disease Control and Prevention (CDC) indicate “an estimated 100,306 drug overdose deaths in the United States during [a] 12-month period ending in April 2021, an increase of 28.5% from the 78,056 deaths during the same period the year before.” Drug overdose deaths have accelerated during the COVID-19 pandemic. This crisis has touched every corner of the United States. Demographic data vary by region, but no group has been unaffected. Blacks, Hispanics, Whites, Asian Americans, and Native Americans of all ages and income have suffered from drug use, addiction, overdose, and death. The CDC outlines three waves in the history of the opioid crisis: a first wave coinciding with an increase in prescription opioid deaths beginning in the late 1990s, a second wave of opioid deaths related to heroin overdose, and a third wave beginning in 2013 related to a rise in synthetic opioid use, particularly fentanyl. The human toll is immense. Between 1999 and 2019 nearly 500,000 people died from opioid overdose. Opioid use has been cited as a factor in at least 7 out of every 10 overdose deaths. More than 2 million cases of hepatitis C and 1 million cases of HIV/AIDS are attributed to intravenous drug use. The opioid crisis has even led to increases in human trafficking cases. Moreover, the CDC 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.” Origins of the crisis To describe the opioid crisis as a public health emergency is an understatement. It is a collective ethical failing by this country and its institutions. The opioid crisis arose and developed from multiple sources. Healthcare workers and hospitals, pharmaceutical companies, and government agencies and politicians are collectively responsible for the hollowing of communities across the country. The opioid crisis originates partly from a desire to address the burden of pain. Pain is multifaceted and has components that are physiological, emotional, social, and cultural. Moreover, chronic pain is a cause of disability and a source of substantial mental health burden. Prior to the 1990s, opioids were generally prescribed to manage acute, cancer-related pain. Beginning in the 1990s, pain management practices shifted. Opioids were increasingly being used to manage chronic, non-cancer pain. Clinical guidelines at the time cautioned the expanded use of opioids and advised that opioids be used discriminately. Pharmacologic treatment should have occurred together with behavioral and psychological care in a multidisciplinary approach. Yet, what ultimately developed was a narrow, unimodal model of care with reliance on pharmacologic solutions to pain. The fragmented landscape of health insurance and access to care…
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The opioid crisis: Origins and humane solutions