Commentary: Government must admit its part in opioid crisis

By Roger Stark / For The Herald

One of the leading public health problems in the United States is the tragically high number of people dying from opioid overdoses. Last year, more than 70,000 people died from a narcotic overdose in the U.S.

Government policy has contributed in several ways to this crisis.

First, in 1970, Congress passed the Controlled Substance Act which formally regulated opioids. The act not only classified drugs based on potency, but also set controls on possession, manufacturing and prescribing of narcotics. The law defined drug enforcement policies.

Medical providers, advocacy groups and government officials recognized that pain management, especially chronic non-cancerous pain, was an issue in the 1980s and 1990s. Both federal and state governments eased restrictions on providers and encouraged initiatives to increase the use and decrease the regulations on prescription pain medicines.

At the federal level, the Joint Commission and the Centers for Medicare and Medicaid set quality prescribing standards for hospitals and doctors. Pain management was made a priority and providers were judged by the number of opioids they prescribed to patients with various types of pain. The number of prescribed narcotics increased dramatically during this time.

Controversy exists as to what constitutes a gateway drug that leads to addiction, however, some prescription drugs are among the primary contenders. The number of overdose deaths was relatively stable until the 2000s and then increased substantially in the 2010s. If prescription drugs are truly the initiating reason for the current crisis, then government officials’ encouragement of their increased use in the 1980s and 1990s should be recognized as a direct contributor.

Second, government officials and the media have recklessly reported prescription drugs as the leading identified drug causing overdose deaths. County and state toxicology tests on people who died of an overdose, however, show the vast majority of identified fatal drugs in the past ten years has been illegal, black market methamphetamine, heroine and fentanyl.

By directing resources to combating legal prescription drugs and their manufacturers, government officials are losing the opportunity to make a meaningful impact on the real causes of the crisis. Likewise, the government should focus on illegal drug manufacturers, dealers and importers rather than spending time and money pursuing minor offenders.

Third, research shows there is a high correlation between drug abuse and mental illness. Only recently have government officials recognized this relationship and allocated more resources to the treatment of mental illness. This should be a priority of government and as a public health issue should take precedence over other social programs of questionable value.

Fourth, there is unquestionable evidence that prescription drug mills contributed to the crisis. There are many examples of clinics and doctor’s offices that provided hundreds of thousands of legal narcotics to communities. One of the responsibilities of the federal Food and Drug Administration is to monitor the public’s use of prescription drugs. The federal Drug Enforcement Administration is tasked with enforcement of existing drug laws. It is unclear why the FDA and the DEA could not detect and prevent the massive number of drugs that some small medical offices were prescribing.

Federal and state governments bear a direct responsibility for the current drug overdose crisis. Historically, government officials have focused on incarceration and punishment of opioid users rather than directing attention to illegal drug manufacturers, suppliers and importers. This can give elected officials the satisfaction of “doing something” even though this is of questionable effectiveness.

One of the primary responsibilities of government is protecting citizens. Elected officials should do their job in protecting the American public by admitting their role in the overdose crisis, by identifying the true nature of illegal drug use, and by directing resources at the true source of the problem.

Dr. Roger Stark is a fellow with the American College of Surgeons and health care policy analyst for the Washington Policy Center.