AUG. 5, 2017 — A member of the City Council of Middletown, Ohio, made national news when he proposed a three-strikes policy on reviving people who have overdosed on opioids. The city, Dan Picard suggested, should limit such ambulance calls to two per person. Overdose a third time, and you’re on your own.
Though that sounds heartless, Picard says the cost of making four or five such runs every day is burning through city money so rapidly it puts all emergency services at risk. “Not only will overdose patients be dying, accident patients will be dying, heart attack victims will be dying,” he told NPR.
We don’t endorse his proposal. But Picard is awakening people to an epidemic that gets far less attention than it deserves. A New York Times analysis finds, opioid overdoses are the leading cause of death among Americans under age 50. Last year, more than 52,000 people died this way — up 19 percent from 2015. For comparison, some 40,000 died in traffic crashes. And the Times calculates that opioid fatalities this year are rising.
Officials in Washington and many states have been slow to react. Last week, though, President Donald Trump’s bipartisan commission on the crisis urged him to declare a national emergency. If 50,000 Americans were dying annually of food poisoning, terrorism or shark attacks, it would get action. But the overdose plague goes relatively unnoticed.
That’s partly because it’s concentrated in small towns and rural areas, where it is less visible to media and policymakers in big cities. It’s also because the drugs used are not sold in open-air markets by violent gangs but often acquired from pharmacies by prescription or ordered online from illicit suppliers. And the scourge originated from good intentions: Doctors were told they needed to be more aggressive in treating pain, using opioids more liberally than before. It sneaked up on us.
Complacency and neglect let the problem mushroom. By now, it’s clear that America needs focused, comprehensive and ambitious policies.
Some remedies have been adopted. Clinics set up to dispense vast quantities of prescription drugs to anyone claiming pain — “pill mills” — have been closed down in many places where they flourished. Every state has (or is creating) a Prescription Drug Monitoring Program that lets doctors check what medicines their patients already have received. These registries help prevent patients from going from one physician to another seeking prescriptions — and discourage doctors from handing them out indiscriminately.
Many emergency medical services stock naloxone to bring back overdose victims before they die. Thousands of lives have been saved as a result. Trump’s commission suggests ways of making that treatment more widely available.
But these solutions go only so far. Crackdowns on prescription drugs lead some addicts to try heroin or buy super powerful opioids like fentanyl on the black market. Fentanyl is especially dangerous because it’s far more potent than other opioids. And administering naloxone saves some addicts who will go on to overdose again.
What else can be done? Offering more treatment programs is an obvious response. The Affordable Care Act expanded private insurance and Medicaid coverage, yielding what Stanford University psychiatry professor Keith Humphreys called “the largest expansion of drug treatment in U.S. history.” The commission proposes changes that would raise the number of Medicaid recipients eligible for residential treatment.
Addicts also can benefit from incentives to get clean. Writing in National Affairs, American Enterprise Institute scholar Sally Satel notes the proven value of drug courts, which can deter drug abuse through “swift, certain and fair consequences when participants fail drug tests or commit other infractions.” They also can encourage offenders to get regular injections of opioid blockers that prevent pleasurable highs.
The dearth of easy ways to reverse this epidemic is no reason for despair. A generation ago, the nation had more than 21,000 drunk driving fatalities a year. By raising the drinking age, toughening penalties, deploying sobriety checkpoints and raising awareness of the risks of driving under the influence, Americans cut the death toll in half by 2015.
Concerted efforts to save lives taken by substance abuse can succeed, given time. The prerequisites: determination and commitment.