Short-sighted: Why the administration’s opioid plan won’t work
https://thehill.com/opinion/5247116-opioid-crisis-prevention/
by Chris Fox, opinion contributor chris@nonopioidchoices.org https://nonopioidchoices.org/
Last week, the Trump administration released a five-step plan to address the country’s opioid addiction crisis. The administration’s new drug czar’s plan focuses largely on attempts to prevent opioid-related overdose deaths.
It won’t work. Here’s why: The plan continues a years-old downstream focus on overdose death prevention and neglects the opportunity to prevent addiction in the first place.
In 2023, the last year for which we have full-year overdose data, 81,000 Americans died from an opioid-related overdose — an average of more than 220 deaths per day. Despite these staggering numbers, the administration’s plan primarily focuses on stopping the flow of illicit fentanyl into the U.S., relying on border control and punitive measures against drug cartels.
While addressing fentanyl trafficking is important, this approach tackles only one part of a far more complex problem. The reality is that overdose deaths remain high not only because of illegal fentanyl but also because millions of Americans continue to receive prescription opioids to manage postsurgical pain, whether they need them or not. In fact, as many as 90 percent of all surgical patients in the U.S. today receive an opioid prescription for post-operative pain.
The administration’s approach also touts increasing access to naloxone and medication-assisted treatment for opioid-use disorder, which are essential components of addiction treatment and overdose prevention. However, these measures are reactive, not proactive. They miss an important opportunity to prevent addiction before it starts by expanding non-opioid pain management options.
Current pain treatment protocols incentivize the use of generic prescription opioids. They do so because such medicines are cheap and well-known to health care professionals, and most patients will tolerate these medicines without incident.
However, some — estimates show between 6 percent and 20 percent — will misuse these medicines. Some may become addicted and move on to other illicit forms of opioids. Some will overdose. Some will die.
This overreliance on prescription opioids strips patients of real choices and unnecessarily increases the risk of long-term dependency. We have the tools to change the status quo.
We must change how we treat pain in this country and ensure that patients and health care providers have options when it comes to treating acute pain. The passage of the Non-Opioids Prevent Addiction in the Nation Act in 2022 was a major step forward, ensuring that non-opioid alternatives are available in outpatient surgical settings.
But there is more work to do.
We must ensure that all patients in all settings can easily access non-addictive pain treatment options. This is especially true for patients covered by Medicare Part D plans.
Earlier this year, legislation was introduced in Congress called the Alternatives to Prevent Addiction in the Nation Act. This critical legislation would make sure that patients can easily access non-opioid medications at the pharmacy counter.
The opioid addiction epidemic is far from over. Hundreds of Americans still die every day, and the crisis is evolving in ways that demand urgent action. Focusing solely on border control and fentanyl supply reduction ignores the deeper issue: how we manage pain in our health care system.
If we are serious about preventing addiction and saving lives, we must prioritize non-opioid choices — before it’s too late.
Every day we delay action, more patients are denied access to a non-opioid pain management tool. Recently, a major insurance company announced that it was making it more difficult for Americans to access non-opioids. We cannot stand idly by and let this happen.
This proposal would ensure that all patients can access non-opioid treatments in all settings. It can prevent addiction before it starts.
Congress has a chance to get ahead of this crisis — but only if they act now. Passing the act is a concrete step toward ensuring that patients have real choices in pain management. If we are serious about preventing addiction and saving lives, we must prioritize non-opioid choices.
We cannot afford to fight the opioid crisis with half measures.
Chris Fox is executive director of Voices for Non-Opioid Choices.
https://nonopioidchoices.org/about/members/
This article was appropriately noted as provided by: by Chris Fox, opinion contributor. I find the adjective OPINION very true, unfortunately, his opinion has very little to do with reality.
Generally, addiction is not caused by Opioids or some other substances that the person with pre-existing mental health issues. They have unknown- to them- “monkeys” on their back and/or “demons” in their head, and their interaction with some substance or activity will silence those “monkeys” or “demons”. They experience a “mental peace” they had no idea was possible. Depending on what statistic one wishes to believe, 0.6% to 3% of the people prescribed an opioid for acute or chronic pain will become addicted. It appears that this organization, Voices for Non-Opioid Choices believes that >97% of anyone dealing with acute or chronic pain should be denied effective, FDA-approved medications.
Recently, I asked www.perplexity.ai the following question: What comorbidities issues are generally involved with addiction?
Comorbidities associated with addiction, also known as substance use disorders (SUDs), are common and can significantly complicate treatment and recovery. These comorbidities span mental health disorders, medical conditions, and behavioral issues. Below is an overview of the most prevalent comorbidities:
Mental Health Disorders
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Depression and Anxiety Disorders: These are among the most frequent comorbid conditions. Many individuals use substances to self-medicate, which can create a vicious cycle of dependency12.
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Bipolar Disorder: Substance abuse often exacerbates mood instability in individuals with bipolar disorder13.
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Post-Traumatic Stress Disorder (PTSD): Trauma survivors may turn to substances to cope with distressing memories and emotions12.
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Personality Disorders:
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Psychotic Disorders: Schizophrenia frequently co-occurs with SUDs, complicating treatment adherence and symptom management13.
Medical Conditions
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Infectious Diseases: Injection drug use is linked to a higher risk of HIV/AIDS and hepatitis.
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Cardiovascular Issues: Stimulant use can lead to hypertension, arrhythmias, and heart attacks.
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Liver and Gastrointestinal Problems: Chronic alcohol or drug use can cause liver damage and gastrointestinal disorders.
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Diabetes and Cancer: Addiction may exacerbate these systemic conditions by hindering proper management46.
Behavioral Disorders
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Eating Disorders: Conditions like anorexia, bulimia, and binge eating disorder often co-occur with SUDs due to shared risk factors such as low self-esteem13.
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Gambling Disorder: Both behaviors share underlying vulnerabilities in brain reward systems1.
Challenges in Diagnosis and Treatment
Diagnosing comorbidities is challenging due to overlapping symptoms, stigma, and limited integration between mental health and addiction treatment services. Untreated comorbidities often worsen outcomes by increasing relapse risks and reducing treatment effectiveness26.
Integrated Care Approach
Effective management requires a multidisciplinary approach that simultaneously addresses addiction and comorbid conditions through personalized treatment plans. This includes pharmacological interventions, psychotherapy, and social support systems tailored to individual needs12.
Addressing these comorbidities holistically improves recovery outcomes and enhances quality of life for individuals struggling with addiction.
Citations:
- https://www.serenityspringsrecovery.com/blog/common-comorbidities-with-substance-use-disorders/
- https://www.euda.europa.eu/spotlights/comorbid-substance-use-and-mental-health-problems_en
- https://www.unodc.org/documents/drug-prevention-and-treatment/UNODC_Comorbidities_in_drug_use_disorders.pdf
- https://footprintstorecovery.com/comorbid-medical-conditions-addiction/
- https://www.youtube.com/watch?v=5RbEotf0jqI
- https://thephoenixrc.com/blog/addiction-recovery/handling-comorbidities-with-substance-use-disorder/
- https://www.ncbi.nlm.nih.gov/books/NBK571451/
- https://nida.nih.gov/research-topics/co-occurring-disorders-health-conditions
- https://altacenters.com/addiction-resources/comorbidity/
- https://www.helpguide.org/mental-health/addiction/substance-abuse-and-mental-health
Answer from Perplexity: pplx.ai/share
Filed under: General Problems
Only 5% of US decedents are autopsied. Only 1/3 of US coroner or medical examiners’ offices have in-house toxicology labs. There is no reason to trust the numbers of deaths linked to opioids based on those realities alone.
But there’s more. For one thing, postmortem changes to the body, chemical, physical and bacterial, make it virtually impossible to make an accurate measurement of the dose an individual may have consumed prior to death. Even if such a measure were possible to do, there’s no such thing as a reliable deadly dose for opioids. Tolerance allows habituated individuals to remain wakeful after a dose that might seriously slow breathing in an individual for whom that amount was their first opioid dose. Individual humans’ inherent metabolic responses to opioids vary widely, as well as individual sensitivity to pain.
Looking at the thousands of years of history during which humans were aware of, and using opium, it’s not uncommon to find mentions that some people resist stopping use once introduced. But there’s an obvious lack of concern about opium being linked to deaths.
Opioid OD is a feedback loop that takes 1-12 hours – uninterrupted. Being in a position in which fresh air is restricted (perhaps by a pillow obscuring the face, or sleeping face down on soft bedding) can contribute. But waking a person up will break the cycle, with no permanent damage.
The link between heroin and rapid death – “the needle was still in the arm” dates back to 1940s NYC. Dealers starting a process called “cutting” where they introduced other substances to stretch the heroin and increase profits. Products such as quinine-based malaria medications, when injected, caused deaths by pulmonary edema. Also, users at the time, as well as then NY State assistant medical examiner Dr. Michael Baden tried to sound the alarm that injecting with alcohol in one’s system could lead to deadly pulmonary edema.
Considering how the supposed substitutes for opioids not only are not reliable treatment for pain, but often have terrible side effects, the government getting between pain patients and the ONLY medication that can reliably treat pain is inhumane. That it’s done in the name of affecting the behavior of others, those who indulge illicitly manufactured or acquired opioids, is injustice on a mass scale.