It’s no longer news that are in the midst of an opioid crisis. It was couple of decades in the making, but we have been wise to it for about a decade. We first responded to it by creating a few prescription drug monitoring programs (PDMPs). Then came ‘abuse-deterrent’ prescription opioids. Followed by more and better PDMPs. And mandatory education about opioids prescribing for doctors. On the heels came mandatory rules about checking PDMPs. Then the CDC guidelines, which accelerated the national reduction in opioid prescribing and dispensing. Each step meant to reduce the supply of legal opioids pushed more people in the arms of heroin, then fentanyl. Each more potent than the other. With each step the overdose death rate rose faster than if we had done nothing.
Meanwhile, we are starting to get concerned about the prescribing of sedating medications for anxiety. And some anti-seizure medications. And in some parts of the country, the rise — again — of stimulants like methamphetamine and cocaine. Meanwhile, alcohol and tobacco continue their massacres, annually killing almost 90,000 and almost 500,000 respectively, without half as much media attention as opioids, which kill less than half as many as alcohol does each year.
We are playing Whac-A-Mole® with drugs, treating mere symptoms of the disease. One drug pops up and we whack it. Then another one jumps at us from an adjacent hole and we smash it. And like the arcade game, we rack up a big score — amount of drugs intercepted, drug dealers caught, drug users incarcerated. And still have nothing else to show for it. One decade ago, we were fretting about people making meth in 2 liters bottles of Coke®. We made it impossible for anyone to buy cold medicine without showing their license to the pharmacy. It didn’t stop meth. Now we are tapering pain patients off opioids irrespective of whether they are addicted or not. This won’t stop opioids.
When the opioid epidemic is finally under control — and it will get under control, eventually — we will begin all over again with the drug du jour. Who knows what it will be then? The face of addiction will change but this horrible disease will continue to stalk us, destroying families and communities. Limiting access to cold medicines, limiting access to pain pills, arresting everyone, increasing access to treatment — these are mere tactics, not strategy. It’s high time we gave up any illusions that we have any kind of national strategy for addiction. We don’t. Until we do, we will continue to suffer.
