Given the scale of the opioid epidemic, the nation should be mobilizing. More people are dying than at the peak of the HIV/AIDS scourge. In some places, overdose deaths are exceeding homicides, suicides and traffic deaths combined. President Donald Trump offered useful actions and ideas at a White House ceremony Thursday, such as measures to prevent addiction with “really great advertising,” create nonaddictive painkillers and bolster law enforcement against illegal imports of the synthetic opioid fentanyl. But Trump’s announcements, including the designation of a public-health emergency, are not enough.
Drug overdose deaths are zooming upward, from 52,898 deaths in the year that ended January 2016 to 64,070 deaths in the year that ended this January, much of the increase due to fentanyl imported from China. Turning the tide is possible. Opioid use disorder can be effectively treated. The U.S. Surgeon General says that only about 1 in 10 Americans with a substance use disorder receive treatment. What the nation really should be doing now is a crash effort to deliver effective treatment to those who most need it - to stop the rising death toll.
Although it didn’t get as much attention as Trump’s, an important statement was made by Food and Drug Administration Commissioner Scott Gottlieb before the House Committee on Energy and Commerce. He declared, correctly in our view, that “given the scale of the epidemic, with millions of Americans already affected, prevention is not enough.” He added, “We must also help those who are suffering from addiction by expanding access to lifesaving treatment.”
The evidence shows that addiction treatments that include medication, counseling and social support can work. In Massachusetts, Gottlieb noted, there was “a greater than 50 percent reduction in the risk of death from overdose among individuals treated with methadone or buprenorphine after a nonfatal overdose.” Researchers say treatment with these medications is life-extending for individuals with opioid use disorder. Treatment can be a road to recovery and lower risk of relapse. Yet there remains a heavy stigma associated with medication-based treatment, a stigma that needs to be overcome. People trying to regain control of their lives with treatments involving medication should not be considered addicted, the commissioner said. Rather, they are “role models in the fight against the opioid epidemic.”
Trump’s list of proposals was a start, but he did not provide the resources the crisis demands. If a public-health emergency is going to cost billions of dollars, better to face that now than wait until later. As Joshua Sharfstein of the Johns Hopkins Bloomberg School of Public Health has pointed out, there are enormous resource demands, many at the state and local levels, for emergency medical services, law enforcement, child welfare, training and treatment. The nation must face the opioid crisis with a more expansive treatment strategy - and more funding - than what Trump has offered so far.