Does Trump Need to Declare an Emergency on Opioids?
“most recent data estimates that 142 Americans die every day from a drug overdose”
While the battle over Obamacare has raged, it has taken attention away from the ongoing opioid crisis. Now, Trump’s own commission on opioids has asked him to declare a national emergency.
Abby Goodnough reports at the New York Times:
White House Panel Recommends Declaring National Emergency on Opioids
President Trump’s commission on the opioid crisis asked him Monday to declare a national emergency to deal with the epidemic.
The members of the bipartisan panel called the request their “first and most urgent recommendation.”
Mr. Trump created the commission in March, appointing Gov. Chris Christie of New Jersey to lead it. The panel held its first public meeting last month and was supposed to issue an interim report shortly afterward but delayed doing so until now. A final report is due in October.
“With approximately 142 Americans dying every day, America is enduring a death toll equal to Sept. 11 every three weeks,” the commission members wrote, referring to the 9/11 terrorist attacks. “Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the executive branch even further to deal with this loss of life.”
In addition to seeking an emergency declaration, the commission proposed waiving a federal rule that sharply limits the number of Medicaid recipients who can receive residential addiction treatment.
It also called for expanding access to medications that help treat opioid addiction, requiring “prescriber education initiatives” and providing model legislation for states to allow a standing order for anyone to receive naloxone, a drug used to reverse opioid overdoses.
Here’s an excerpt from the commission’s recommendation:
Dear Mr. President:
I am proud to present to you today the interim report prepared by your Commission on Combating Drug Addiction and the Opioid Crisis. This interim report is just a start; our work is ongoing and we will have more to share with you and the nation later in the Fall of 2017. We now recommend several actions for you to take as our nation’s Chief Executive and someone who spoke passionately on this issue in the 2016 campaign.
Our nation is in a crisis. Your Executive Order recognized that fact. The work of your Commission so far acknowledges the severity of this national problem.
According to the Centers for Disease Control (CDC), the most recent data estimates that 142 Americans die every day from a drug overdose. Our citizens are dying. We must act boldly to stop it. The opioid epidemic we are facing is unparalleled. The average American would likely be shocked to know that drug overdoses now kill more people than gun homicides and car crashes combined. In fact, between 1999 and 2015, more than 560,000 people in this country died due to drug overdoses – this is a death toll larger than the entire population of Atlanta.
As we have all seen, opioids are a prime contributor to our addiction and overdose crisis. In 2015, nearly two-thirds of drug overdoses were linked to opioids like Percocet, OxyContin, heroin, and fentanyl. This is an epidemic that all Americans face because here is the grim reality: Americans consume more opioids than any other country in the world. In fact, in 2015, the amount of opioids prescribed in the U.S. was enough for every American to be medicated around the clock for three weeks.
Read it all here.
NBC News puts the number of affected Americans in greater perspective:
One in Three Americans Took Prescription Opioid Painkillers in 2015, Survey Says
How many Americans are using prescription opioid painkillers? About one in three.
That’s the stunning number in a new survey released Monday from the National Institute on Drug Abuse, which calculated that a whopping 91.8 million Americans used drugs like OxyContin or Vicodin in 2015.
And nearly five percent of the adults surveyed told researchers they took these drugs without their doctor’s permission, the study reported.
They didn’t get their meds from some seedy drug dealer, either.
“The most commonly reported sources were friends and relatives for free,” the study reported. “Or a physician.”
If there is one area of healthcare where Democrats and Republicans should be able to find common ground, it is here. We don’t need another war on drugs, but we do need common sense solutions to deal with this very real problem.
Featured image via YouTube.
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40,000 men and women every day
Blue Oyster Cult.
You are thinking like a Democrat. In the big picture 142 is not all that much.
how does that compare to medical errors/mistakes, and just catching a fatal disease in the hospital or for that matter doctors giving patient meds they don’t really need.
I do not have the numbers to compare it to medical mistakes. But quite simply – every year as many Americans die from opioid overdose than died in the ENTIRE Vietnam War.
Have to look at what type of opioids they are OD’ing on. Crap that dealers are pushing full of who knows what to cut it, animal tranks, or FDA approved meds from the pharmacies? It’s easy to group everything under the word opioid and then say all opioids are killers. Easy but very dishonest. The opioid epidemic started when they went to war on the patients that were Dr shopping for pills. So they shut down a percentage of law breakers who were abusing the system and punished a large group of patients and Dr.’s who are in need of relief. Prohibition once again because it worked so well the first time.
Wrong. We need less regulation.
Good questions, but it was outside the scope of the Executive Order – https://www.whitehouse.gov/the-press-office/2017/03/30/presidential-executive-order-establishing-presidents-commission .
“…we do need common sense solutions to deal with this very real problem.”
Will the solution be a typical one — treat the symptoms? Or, will the solution address the causes of the pain and the cause of the current opioid solution that only addresses symptoms?
If I drink two six-packs every night and wake up with a hurting head every morning, is the solution a better pain killer or fewer beers? Or better control of the pain killers?
I suspect the solution will be another layer of controls that address symptoms, drive up costs, and require a bigger government.
Yeah, another commission and committee and more laws, that always works. Decriminalize every substance. Walking over drunks and junkies was the greatest anti drug experience I ever had. Darwin in action.
As the husband of someone who takes an opioid for chronic pain, we have to endure the “state of emergency” approach taken by New York on opioids.
It reminds me of the security theater of the TSA … legitimate and responsible patients and their doctors have to jump through more and more hoops to prove they aren’t abusing. And I have to question just how much abuse they are preventing … as opposed to forcing legitimate users into a Catch-22 of either living with insufferable pain or hitting the streets for relief.
I take a hard line on drug abuse … I consider its objective of altered perceptions, which INEVITABLY compromises self-control, anathema to a free society if it wants to stay free.
But declaring such an “emergency” is nothing more than an exercise in good intentions and virtue-signalling that makes life harder for those who need that pain relief … even as this nation keeps trying to have its cake and eat it too when it comes to recreational drug use; decrying abuse while snickering when a politician says “I didn’t inhale!”.
Besides enabling more government waste and bureaucracy, I am not sure what declaring an emergency does
The focus should be on prevention first. That is the highest return on intervention.
Unfortunately, it is incredibly hard as well, as the roots of this are not the chronic pain person who becomes addicted which is a relatively rare source and more easily treated member of the chronically addicted.
A strong economy, strong families help prevent some from falling into a life of drugs because of poverty and poor life choices. It also enables local communities the ability to fund treatment on a local basis without the fraud of federal programs.
“waiving a federal rule that sharply limits the number of Medicaid recipients who can receive residential addiction treatment”
This program is incredibly fraud infested. Non-existent residents are billed for. Drug addicts are recruited and given money for drugs in exchange for being billed for.
This is a hard problem with many individual root causes. And a blanket restriction on these prescriptions doesn’t solve it as many end up on them from a path based in heroin abuse. OxyContin and heroin use are linked and are substituted, e.g. As one goes up the other goes down.
Opioids solve a real problem with debilitating pain. If you have ever taken them, as I have had to, they solve a real problem in quality of life when recovering from serious injury.
Pharmaceutical companies today provide a real solution for addiction treatment with the drugs available today. The other partial answer from Pharma companies is innovation if new and safe pain alternatives that will reduce supply of opioid prescription drugs.
This will likely drive the epidemic back to heroin and increase the number of deaths from overdose and other issues.
Whether it reduces the number of new addicts is unclear as it is not certain that access to prescription opioids is a driver of addiction rates when heroin is becoming cheaper and more accessible, or if opioids represent a safer form of heroin style drug that those pre-disposed to drug addiction seek out.
There is no easy answer. Declaring an “emergency” solves nothing.
“We don’t need another war on drugs, but we do need common sense solutions to deal with this very real problem.”
So you support the current practice of torturing those who need pain killers for chronic pain by denying them drubs and jailing doctors who try to help these patients manage their pain? I mean, that’s the current situation all in the name of the “War on Drugs”. Or do you advocate ratcheting up another one to two notches?
And I notice what you talk about “common sense”. So what do you consider common sense? And what do you plan to do about the casualties in the current state of affairs? Anything at all, or are you going to stick to rhetoric and let our “betters” dictate how we must suffer to “end this crisis”?
If there is Karma in the world those who advocate more government regulation/intervention/abuse/torture in the area of opioids suffer the same chronic pain many people endure in the name of this crisis. Then they can enjoy the fruits of their labor and maybe, just maybe, gain a smidgen of insight into the pain and suffering people endure in the name of their vaunted morals.
Is it strange that we have such a state of emergency since they’ve cracked down on opioid prescriptions by Dr.’s? The procedures in place for anyone who wishes pain management is insane. You have to prove you are taking the meds every visit, go pee in a cup and pay for the drug test. You have to bring in all your scripts and get everything counted and you better be at the right amount. 28 or 30 day scripts no buying several months to save money. All of this is to stop people from selling a controlled medicine on the street? So the government would rather have people buying who knows what on the street instead of FDA approved meds? That is why there are opioid OD’s, it’s the crap that the dealers are pushing killing people not the percs or vikes that Joe schmuck is selling to a guy he knows.
FFS didn’t the government learn anything from prohibition?
“…didn’t the government learn anything from prohibition?”
I figure that was a rhetorical question, but no. The answer is ALWAYS more government.
I know for a fact that there were/are people on Medicaid and SSDI who receive opiates for pain and then sell them for $5-20 a pop.
Pretty good supplemental income with a 90 count/month bottle of Vicodin.
On the other hand, I also know people who truly need pain relief who have a helluva time getting them
This is a none issue, made up. I take care of a wide variety of people and do not see anything like what is described. There is no such thing as addiction like they represent. People who have problems with drugs are mentally ill. That is only 10% of the population. In the meantime others are not getting needed medication due to over regulation. I saw the head of the drug enforcement in my office for my area and he said they see none of this. Yet my state people go on about the mythical problem. You can get these drugs across the counter in many countries. A friend recently bought Xanax across the counter in Germany. And these countries have fewer issues than us.
We do not have an opioid epidemic. It does not exist. We do have an over regulated drug industry and politicians pushing an agenda that is already excessively over legislated. I see just the opposite from too many drugs, I see people who are hurting just to satisfy a political agenda that has no basis in sense. I saw the head on my regional drug enforcement in the office not long ago and he indicated that he has no knowledge of this supposed problem. The fact is that there are not any safe drugs for a doctor to give, other than opiates. The government has outlawed all other alternatives. Most countries have no issue with selling these and similar medications across the counter wWe do not have an opioid epidemic. It does not exist. We do have an over regulated drug industry and politicians pushing an agenda that is already excessively over legislated. I see just the opposite from too many drugs, I see people who are hurting just to satisfy a political agenda that has no basis in sense. I saw the head on my regional drug enforcement in the office not long ago and he indicated that he has no knowledge of this supposed problem. The fact is that there are not any safe drugs for a doctor to gWe do not have an opioid epidemic. It does not exist. We do have an over regulated drug industry and politicians pushing an agenda that is already excessively over legislated. I see just the opposite from too many drugs, I see people who are hurting just to satisfy a political agenda that has no basis in sense. I saw the head on my regional drug enforcement in the office not long ago and he indicated that he has no knowledge of this supposed problem. The fact is that there are not any safe drugs for a doctor to give, other than opiates. The government has outlawed all other alternatives. Most countries have no issue with selling these and similar medications across the counter without prescription. In fact, in Amsterdam you can buy anything you want, even mushrooms. And they have fewer problems than we do. We need to allow people to buy whatever they want. This would greatly decrease the problems with cost of medicine. Also, there is no such thing as addiction as you might think. Most of the people that abuse drugs are mentally ill. I have never had an addict who developed his problem with the medications that I have administered in 40 years of practice.ive, other than opiates. The government has outlawed all other alternatives. Most countries have no issue with selling these and similar medications across the counter without prescription. In fact, in Amsterdam you can buy anything you want, even mushrooms. And they have fewer problems than we do. We need to allow people to buy whatever they want. This would greatly decrease the problems with cost of medicine. Also, there is no such thing as addiction as you might think. Most of the people that abuse drugs are mentally ill. I have never had an addict who developed his problem with the medications that I have administered in 40 years of practice.ithout prescription. In fact, in Amsterdam you can buy anything you want, even mushrooms. And they have fewer problems than we do. We need to allow people to buy whatever they want. This would greatly decrease the problems with cost of medicine. Also, there is no such thing as addiction as you might think. Most of the people that abuse drugs are mentally ill. I have never had an addict who developed his problem with the medications that I have administered in 40 years of practice.
The real crisis is people in pain who cannot get the medicine they need.
We do not have an opioid epidemic. It does not exist. We do have an over regulated drug industry and politicians pushing an agenda that is already excessively over legislated. I see just the opposite from too many drugs, I see people who are hurting just to satisfy a political agenda that has no basis in sense. I saw the head on my regional drug enforcement in the office not long ago and he indicated that he has no knowledge of this supposed problem. The fact is that there are not any safe drugs for a doctor to give, other than opiates. The government has outlawed all other alternatives. Most countries have no issue with selling these and similar medications across the counter without prescription. In fact, in Amsterdam you can buy anything you want, even mushrooms. And they have fewer problems than we do. We need to allow people to buy whatever they want. This would greatly decrease the problems with cost of medicine. Also, there is no such thing as addiction as you might think. Most of the people that abuse drugs are mentally ill. I have never had an addict who developed his problem with the medications that I have administered in 40 years of practice.
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The medical system generates massive federally subsidized revenue by treating every real or perceived malady from toenail fungus to cancer in 90 year-olds. Its great for the present recipients but its not sustainable folks.
How many medical “problems” would resolve on their own if we could only return to the days when the Doctor said “take two aspirin and call me in the morning.”
I think that we are having more people in the “wait & see” mode due to the ACA. With high premiums and deductibles, who can afford to visit the doctor and have to pay for a bunch of tests that will show nothing and cost too much? I realize that I get the super “discount” from “suggested retail prices”, but even then, it adds up very fast.
Let the Doctors deal with it , if they can keep people on a managed safe dose , so be it . if we force a cut off then people will find them where they can .
The emphasis should be on the drug trade that is targeting teens. If an adult wants it , he /she will get it somehow.
“we do need common sense solutions to deal with this very real problem.”
The one “common sense solution” everyone will agree on is “treatment.” Yet drug treatment is costly and mostly ineffective.
It’s ineffective because the similarities between behavioral and physical health are overstated. Perhaps motivation has some minor influence on the effectiveness of treatments for cancer or tuberculosis, but for substance abuse disorders it is all-important.
Perhaps that’s because cancer, tuberculosis, etc. do not provide those who are ill with these diseases with pleasure, yet opiod abuse obviously does. Or because there’s far more human agency (aka choice) involved in drug abuse than in physical maladies.
Even for the highly motivated, long-term success rates remain depressingly low, but for those who are “in treatment” due to pressures from family or friends or because of a court diversion program, “success” is likely to exist only as long and to the extent the treatment provider needs to claim it exists in order to get paid.
So, yes, it’s a very real problem. BUT that doesn’t mean a flood of government money into treatment (mandates and subsidies) is any sort of real solution. Other than for those providing the treatment services, of course. Who, once the flood starts, will form lobbying groups to ensure that, once started, the money flood will continue forever.
If there is one area of healthcare where Democrats and Republicans should be able to find common ground, it is here. We don’t need another war on drugs, but we do need common sense solutions
“Common ground” and “common sense”? These seem mutually exclusive.
What do Democrats and Republicans find in common? Only one thing, really—the reliable ability of any government “investigation” to reveal the need for more government spending and control. And if they can’t find one, they’ll make one up. As they seem to have done here.
It’s not generally realized that much government regulation is devoted to making things poisonous. The most obvious example is alcohol. In its mania to control (or, more specifically, to tax) alcohol—but do it without actually destroying a large chunk of modern medical practice as well as industrial production—government requires that much of our alcohol be made poisonous. This is solely so that people won’t drink medical or industrial alcohol instead of drinking the stuff which is taxed.
The very concept is grotesque.
And if you want to get your ear talked off, ask any licenced physician about the whole Percodan-Percocet thing, both bowdlerized versions of a much more useful drug. And why are they bowdlerized? Because of the government’s terror that somebody may take drugs for a “high” (or, worse, a “high” which isn’t taxed excessively). Percodan and Percocet both have things added; and added solely to make you seriously ill before you take enough of the drug to reach that dreaded “high”.
We are being poisoned by government fiat, and have been for almost as long as there’s been a US government. It’s not going to stop, but that doesn’t mean we have to be enthusiastic about it.
As others have pointed out they use the vague term “opiod”.
Something they fail to point out. Heroine is an opiod.
Makes you wonder. What aren’t they telling us.
So, who has a government solution that will target the abusers and not further restrict the law abiding?
No one?
The annual age-adjusted suicide rate is 13.26 per 100,000 individuals. Men die by suicide 3.5x more often than women. On average, there are 121 suicides per day.
That IS a crises worthy of attention.
I just read a Twitter feed that mentioned that the person’s father committed suicide because of addiction. I would have to wonder about the cause of death – suicide or overdose?
BTW – the comments to the thread have many people saying that they had a family member or friend commit suicide due to pain or addiction.
https://twitter.com/bethanyshondark/status/892440193810255872
My mother killed herself after a couple of decades of the Dr. giving her plenty of “Mothers Little Helpers”(Valium).
Started back in the late 60’s, when the pharmacist would give them to her and just tell her to bring in a new script when she got it. Dr. never once tried to wean her off them.
When she did try to get it right, the swing to Prozac put her over the edge and she found a Dr to give her more V.
OD’d intentionally on Valium, Librium and Prozac.
The EO has stated missions – identify & describe existing Federal funding, assess availability of services & under served areas, identify & report on best practices, review literature on the effective of educational messages, identify and evaluate existing Federal programs & make recommendations for improving them.
The commission serves without compensation, though expenses are paid. They had a 90 day interim reporting requirement, which they missed by 30 days. They have a final reporting date of October 1, though they can ask for more time. The Commission ends 30 days after the final report, unless President extends the date.
(https://www.whitehouse.gov/the-press-office/2017/03/30/presidential-executive-order-establishing-presidents-commission)
Many of the EOs that establish commissions to study something have a similar set-up of a stated mission, reporting requirements, limited expense reimbursement and termination date. This is a change from the “czar” setup of the Obama Administration.
The interim report is clearly labeled “DRAFT” and is currently 10 pages long. There are eight recommendations listed as well as eleven issues which are still being reviewed. The report lists the types and sources of input, including contacting all governors, many organizations and people.
The news reports seem to focus on the “emergency” declaration request, but the interim report refers to declaring it under two specific acts – Public Health Service Act or the Stafford Act. So, there may be some limitations of action under those acts.
Read the interim report. It is very interesting and deals with many of the comments and questions mentioned above. It is always better to review the source document than rely on summaries which may be biased.
https://www.whitehouse.gov/sites/whitehouse.gov/files/ondcp/commission-interim-report.pdf
https://www.theguardian.com/us-news/commentisfree/2016/jun/08/opioid-epidemic-drug-mix-overdose-death
What opioid hysteria leaves out: most overdoses involve a mix of drugs.
Surprise!
Opium derivatives are some of the most physically addictive compounds on Earth. And, once a person becomes physically addicted, there is no cure, Regular opioid use causes permanent physical and chemical changes in the human body. These changes can be mitigated, but not totally reversed. The most common form of treatment is replacement therapy, using less powerful synthetic opioid type drugs. Such therapy requires long-term, if not life-long, treatment. That is expensive. And, that is the reason why commission such as that mentioned above want opioid use declared an emergency. So that government funding will be provided to pay for this type of treatment.
The death toll, from opioid abuse is bad enough. But, the less deadly results cost the people of this nation an enormous amount of money and emotional pain every year. The problem with the “opioid epidemic” is that the drugs provide an effective initial relief from pain. Their use to treat chronic pain is less reliable, due to increased tolerances and side affects. But, the medical community has viewed these drugs as the easiest, most effective way to treat a specific symptom [pain] while largely disregarding its other, long-term effects on the human body. And, this has led to medical abuse of the drugs. People feel better while they are taking the drugs. But, if they stop, the pain symptoms usually appear. And, if they have taken a large enough dosage for a long enough period of time, they have developed a physical addiction which is then treated with applications of similar drugs.
But, the largest problem is the human desire to use chemicals to alter perceived reality. This is not a recent phenomenon, going back to the dawn of recorded history. Every chemical that humans take, which alters perception or mood, has been abused, almost as soon as it is introduced. As long as people refuse to change, use of drugs will continue and we will suffer the effects.
Wrong. In 40 years of treating patients I have never had an addict and I prescribe the drugs daily. Don’t believe what comes from government.
I am sorry that my commenting is bad as the machine I am using stinks. Now, everything that you have written about addiction can be proven beyond a doubt to be in error. It is the propaganda put out by the government. People can take narcotics and not get “addicted”. Instead, what you have is those that abuse the drugs as self treatment for mental illness. Many countries sell the stuff across the counter, in fact, that is where most of the street drugs come from, it is sold in Mexico and comes across the border, not from US doctors.
Canada doesn’t have a problem selling 222’s or ACC’s over the counter. They mix their codeine with caffeine to counter it. Common sense answer from the North.
Sorry, but hundreds of successful prosecutions of doctors all across the country for over-prescription of opioids which have led to thousands of addicts say that you are wrong.
It is true that the vast majority of opioid addicts are created by the illegal use of opioids, by individuals, to self medicate. As I noted this has always been a problem. However, the treatment that I describe is the current accepted treatment for opioid addiction. Here is a description of the process:
-Opioid withdrawal is uncomfortable, and heavy users may experience the most severe symptoms. Fortunately, detox and withdrawal programs include the medications methadone, clonidine, naltrexone, and buprenorphine, which act much as the opiate does in the body without providing the euphoria that addicts feel. In specially-metered doses, these drugs help the body through withdrawal with minimal, if any, discomfort. Patients will continue the medicinal treatment through the next stage of rehab and after that stage is finished.-
These drugs and this treatment is very expensive and someone has to pay for it. Hence declaring an opioid addiction epidemic.
Not everyone who takes opioids becomes addicted. A lot depends upon the strength of the medication, the type of opioid, the duration and the physical and mental make-up of the user. But, it does happen regularly if long-term, moderate to high dosages of the drug are used. And, there is no magic bullet to treat said addiction.
Seems like another money grab. Requesting a 50 state waiver to open up funds for treatment of SUD as a mental mental health issue under Medicaid. Then putting Dr’s and Dentists still in school through training about opioids and continuing education courses for professionals, fund more methadone for Medicare, mandatory naloxone for certain prescriptions and for all police agencies.
It’s just price tag on the latest war on drugs, but it’s being paid for under meidcaid.
The key is that people with mental health issues will use anything to alter their state of mind. Right now opioids is the go to, in the past it was booze, then weed, coke, paint, etc etc. Maybe we could do something about our mental health system instead and nip all of this in the bud before the next synthetic high strikes???
Rising to the issue… in Alaska…. new legislation requires recheck of EVERY patient when over 7 days of meds prescribed… requires re-eval by MDs every time. So patients who need meds get tossed into the hopper for everything. The war on drugs is a failed war now fought against legitimate use of meds.
Big problem has aways been illicit drugs of questionable purity and strength…. get a good batch and you may die if using poor cut drugs as reference. This just boosts to black market.
As with prohibition… there are always addicts….. but as with that disaster… all the laws do is enrich and empower organized crime.
Of all the addictions… the “safest” can be opiates….
I’m not really buying into this “epidemic”. If the numbers are true…,that 1/3 of all Americans were on opioids at one point or another in 2015, then the death rate is actually tiny compared to the number of people obtaining relief by taking these meds.
I cannot stand pain. It is such a comfort to know that if I have any sort of medical procedure done…dental, kidney stone, broken bone, surgery, whatever….that I can alleviate the pain. I also get horrible migraines, and my migraine medicine has codeine in it as one of many ingredients. It’s the only medicine that gives me relief.
I’d be angry if the govt regulated these drugs to the point that I had to suffer simply to avoid problems in a teensy proportion of users. Honestly, the thought of that is really infuriating.
Government intrusion into the treatment of chronic pain, by licensed physicians, is just another “We (professional politicians) know what’s best for you.” Akin to “throwing out the baby with the bath water.”
But yeah, let’s give them control, over all medical decisions,including life and death, by instituting Single Payer Healthcare.
That was sarcasm for the slow witted:)