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Addressing America’s Epidemic of Opioid Addiction

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UPDATE: Since CRN published the Solutions Center below about addressing America’s epidemic of opioid addiction in October, Congress has acted on a couple of the measures discussed. In October and November of 2015, the Senate and House passed the Protecting Our Infants Act, and the president signed it into law. Sponsored by Senate Majority Leader Mitch McConnell (R-KY), the statute will help both to prevent and treat maternal opioid abuse and to treat the more than 20,000 babies who are born each year suffering from withdrawal.

Earlier this month, the Senate voted 94 – 1 to pass the Comprehensive Addiction and Recovery Act (CARA), sponsored by Sens. Sheldon Whitehouse (D-RI), Rob Portman (R-OH), and Kelly Ayotte (R-NH). CARA would authorize resources to state and local governments as well as nonprofits to pursue proven strategies – including education efforts, treatment programs, and recovery services – to combat addiction. CARA awaits consideration in the House.

The menace of opioid abuse and addiction haunts every community and corner of America, and the measures mentioned in the Solutions Center that follows are critical to fighting this public health crisis.

The Challenge

The United States is suffering an epidemic of opioid addiction. Prescription drug abuse and heroin addiction are tearing apart families and communities, and the staggering statistics are tragic and heart-wrenching:

  • In 2013, an estimated 517,000 Americans, including 10,000 adolescents under the age of 18 and 182,000 young adults aged 18 to 25, were addicted to heroin.
  • The number of Americans addicted to heroin is nearly three times higher than a decade ago.
  • Deaths from drug overdoses significantly outpace deaths from motor vehicle accidents; in 2013, 43,982 Americans died from a drug overdose while 33,804 died as a result of a motor vehicle accident.

For many opioid addicts, their path to addiction starts with narcotic prescription painkillers like oxycodone fentanyl, and hydrocodone/acetaminophen. Opiate-based drugs, which are highly addictive, have become a common way to manage pain. Between 1991 and 2013, the number of prescriptions for opioids grew by over 270%. The increased prevalence of these prescription drugs made them more accessible for non-medical use and led to more cases of opioid addiction.

In response to the increased abuse of opioid-based painkillers, policymakers and the medical community have sought to shut down “pill mills,” which include doctors, pharmacies, pain clinics, and other facilities that loosely administer prescription narcotic painkillers. With the crackdown on pill mills, the supply of opioid-based painkillers has declined, and their price increased. As a result, opioid addicts have increasingly turned to another opiate: heroin, which has become cheaper and more accessible than prescription painkillers.

Because so many opioid addicts start off using prescription painkillers, addiction to opiates does not discriminate. It knows no boundaries in terms of race, class, or age.

Addicts are not the only victims of this epidemic. Organized crime from the drug trade infiltrates our communities.

Worse still, families agonize as close relatives fall deeper into the scourge of addiction. They suffer again when their relatives, fighting the disease of addiction, cannot access treatment and are incarcerated.

In many parts of the country, addicts, who need and want treatment, face significant wait times to access it. Some of the most successful treatments for opioid addiction involve medication assistance. Yet federal regulations place limits on who can provide such medication and the number of patients they can treat at a time.

Perhaps the most innocent victims are the over 20,000 babies born each year to mothers addicted to opioids. These babies suffer from what is called neonatal abstinence syndrome which requires lengthy and costly hospital stays.

DEATHS FROM DRUG OVERDOSES VS. FROM AUTO ACCIDENTS

Percent by which deaths from drug overdoses exceed deaths from motor vehicle accidents, 2013

The Solution

There is no single solution to this epidemic. Confronting this challenge requires a comprehensive community-based approach that involves prevention, interdiction, and treatment. The federal government has an important role to play in supporting these efforts. Policymakers have put forward a variety of proposals, and a combination of these initiatives would represent an appropriate response to the current epidemic. These proposals include:

  • Lifting the current 100-patient cap on physicians who have waivers to prescribe medicine to opioid-addicted individuals, as proposed in the Recovery Enhancement for Addiction Treatment Act;
  • Authorizing office-based opioid treatment programs, as proposed in the Opioid Addiction Treatment Modernization Act;
  • Developing best practices for prescribing opioid-based drugs, establishing a national awareness campaign, and supporting states in carrying out prescription drug monitoring programs, as proposed in the Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015;
  • Authorizing a series of federal grants to assist states, local governments, and non-profits in combatting the heroin and opioid epidemic, including the development of state and community plans, education efforts, and treatment programs and recovery services for targeted populations, as proposed in the Comprehensive Addiction and Recovery Act of 2015;
  • Establishing a drug management program under Medicare for at-risk beneficiaries, as proposed in the Stopping Medication Abuse and Protecting Seniors Act; and
  • Collecting and disseminating strategies as well as best practices to prevent and treat maternal opioid abuse, and providing recommendations to diagnose and treat babies suffering from withdrawal, as proposed in the Protecting Our Infants Act of 2015.

The Conservative Principle In Practice

Conservatives generally believe that government shouldn’t make decisions for people that they can make for themselves. Highly addictive substances, which substantially alter behavior and inhibit a person’s ability to control his behavior while under the influence, deprive a person of his freedom and agency. In addition, sometimes the choices of individuals, businesses, or other private groups affect actors other than themselves. While local communities are on the front line in confronting problems arising from drugs, the federal government has played an important role, especially as it relates to prescription drugs and controlled substances.

Localize It & Personalize It

The Office of National Drug Control Policy has state-by-state information on drug use here: https://www.whitehouse.gov/ondcp/state-map.

The Champions

Sponsors of legislation that would address America’s epidemic of prescription drug and heroin abuse include:

Response To Common Arguments 

Charge: While the epidemic of heroin and opioid abuse is a serious problem, it is one best handled by state and local governments, not the federal government.

Response: Much of the current epidemic can be traced to prescription drug abuse. The federal government plays a role in regulating access to prescription drugs. In addition, the federal government also regulates the availability of medication-based treatments for opioid addiction. Beyond regulation, the federal government has an important role to play in supporting local communities with best practices and resources as they battle a drug epidemic. While state and local officials and community organizations must be at the forefront of confronting this challenge, the federal government should help support their efforts.

Message Points

  • America is suffering an epidemic of opioid addiction with, as of 2013, nearly 2 million Americans addicted to opioid-based prescription painkillers and over 500,000 addicted to heroin.
  • As prescription narcotic painkillers have become more difficult to obtain, opioid addicts, who cut across all races, ages, professions, and classes, are turning increasingly to heroin.

  • The scourge of opioid addiction affects not only addicts but also families, communities, and even babies.

  • While there is no single or simple solution to the epidemic, policymakers should ensure the federal government better and more fully supports state and local governments’ efforts to combat the crisis.