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Need to Treat, Not Just Prevent, Heroin Addiction

(Pixabay)

Last month the US House of Representatives, cognizant that all 435 members are up for re-election in November – with very little to show for it legislatively – passed more than 50 bills dealing with the opioid epidemic and drug abuse in general.

Despite the number of bills, they probably won’t accomplish much because, according to the New York Times, drug rehabtreatment is not the primary focus of this crop of bills”.

That focus is on prevention, changing behaviors that lead to addiction. Since many politicians still think of drug addiction as a matter of weakness of character, preventing addiction is more appealing than helping sinners get better.

Over-prescribing of opioid painkillers for chronic pain is one problem because oxycodone and hydrocodone provide less and less pain relief over time as the body builds up a tolerance to it. That means dosages have to increase, also increasing the risk of addiction and escalation to stronger black market drugs, including heroin and fentanyl. (This has an unfortunate side effect of making it more difficult for people who legitimately need pain relief to obtain it. They sometimes also turn to the black market.)

Prescriptions already have been dropping, but the number of overdose deaths continues to increase. In 2016, the Centers for Disease Control reports, 42,249 overdose deaths involved an opioid, an average of 115 opioid overdose deaths per day. That suggests either that new addicts aren’t the problem, or they are bypassing legal prescriptions entirely and going for heroin and fentanyl from the start.

At least some of those deaths are due to adulterated street drugs or stronger drugs masquerading as popular drugs. Fentanyl is 50 times as strong as heroin, but is sometimes mixed with heroin or pressed into counterfeit OxyContin pills. If you take a much stronger opioid than the one to which you are accustomed, it is much easier to overdose accidentally.

Harm reduction services, such as safe injecting sites where clean needles and drug testing are provided for free, save lives and prevent the spread of diseases such as AIDS and hepatitis, but the new House spending does not cover such services.

It also does not include coverage for methadone treatment, the most effective drug in medication-assisted treatment (MAT) for preventing overdose deaths. (Buprenorphine, the second most effective MAT drug, is covered by the new legislation. Both drugs are disliked by some politicians and drug court judges because they are “just substituting one drug for another”.)

Eighteen months into the Trump administration, and we’ve seen little progress towards stopping the opioid epidemic. All the prevention programs in the world won’t do a thing if the existing addicts aren’t taken care of. All those House bills won’t make a difference if the Senate doesn’t agree to them and if the President doesn’t sign them.

It’s time to stop playing politics. When addiction treatment is easier to get than more drugs, more addicts will quit. That should be the goal of Congress and the White House.