Forget the Wall—the Opioid Crisis Is Trump’s Real National Emergency

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President Donald Trump has repeatedly threatened to declare a national emergency if Congress refuses to pony up $5.7 billion to build the “ great, great wall ” he promised his base during the 2016 election campaign. In an apocalyptic televised address early in January, he even warned—falsely, as fact checkers revealed during the speech—that a tsunami of hard-core criminals and drugs was sweeping across the US-Mexican border.

Fabricating national emergencies is unconscionable, especially when there are real ones requiring urgent attention.

Here’s an example: Since 1999, 400,000 Americans have died from overdoses of opioids, including pain medications obtained legally through prescriptions or illegally, as well as from heroin. The Centers for Disease Control (CDC) notes that prescription medications were involved in 218,000 of those fatalities.

Even the president labeled opioid addiction a “public health emergency” after a commission he appointed in March 2017 issued a report detailing its horrific consequences. Trump’s efforts led Congress to allocate $6 billion to combat the crisis in 2018 and 2019, and the president sought another $7 billion for 2019. Since then, however, his attention has turned to the “emergency” along the border with Mexico, the equivalent, by comparison, of a gnat bite on an elephant.

His initial urgency regarding the opioid epidemic seems to have dissipated, though not his propensity for making false claims. At a May 2018 rally, for instance, he declared that, thanks to the $6 billion, “the numbers are way down.” If the president meant overdose deaths, however, his claim was blatantly false. Data from the CDC show that, between 2016 and 2017, prescription opioid overdose deaths decreased by a mere 58 from 17,087 to 17,029. As for overdose deaths from opioids of all sorts (whether legal and doctor-prescribed or illegal, as with heroin), they increased by 12 percent.

Congressional critics charge that the commission’s raft of recommendations hasn’t been implemented energetically, noting in particular Trump’s proposed $340-million cut to the budget of the White House Office of National Drug Control Policy, which coordinates the government’s anti-opioid campaign. And given the scale of the epidemic, experts maintain that $6 billion over two years doesn’t come close to what’s needed to make a real difference.

The Toll Taken on Trump’s Base

High-voltage opioid painkillers were once derisively labeled “ hillbilly heroin ,” but that moniker has become archaic and misleading. While the misuse of such medications tends to be proportionately higher among the poor and in areas with high unemployment, it now spans classes and regions. In the late 1990s, the surge in overdose deaths did start in economically depressed rural communities and small towns—in Appalachia in particular. Since then, however, the crisis has spread to suburbs and cities across the country. View our current issue Still, a strong correlation does exist between opioid addiction, overdose death rates, and economic distress, especially in small towns and rural regions , including Maine’s logging communities , areas reliant on commercial fishing , and Appalachian coal towns. In rural New Hampshire, where I spend part of the year, it doesn’t take long to start hearing about, or meeting, people whose lives have been upended by opioid addiction. Such communities were the first victims of the epidemic because their economic decline produced despair, hopelessness, and diminished self-worth. Moreover, plenty of people suffered chronic pain, whether from workplace accidents or physically demanding jobs.

President Trump ought to be particularly attentive to the country’s raging opioid addiction. Many of the hardest hit places are home to the very voters who helped elect him. During the 2016 presidential campaign, he presented himself as their champion, bemoaning the hardships of factory workers, miners, loggers, and others zapped by layoffs or wage cuts and living in communities in which the better-paying jobs on which they had depended, often for generations, were disappearing.

Staggering Statistics

Data from the National Institutes of Health reveal that overdose deaths from all categories of opioid drugs—legal and illegal—soared from 10,000 in 1999 to 49,068 in 2017, with the numbers consistently higher for men. But heroin fatalities (15,958 in 2017) must be included in the mix because the use of that drug and of prescription opioids has become intertwined.

Although less than 5 percent of those who misuse opioid pain medications drift to heroin, nearly 80 percent of heroin users start by misusing opioids. In addition, both people hooked on such painkillers and recreational users often combine them with heroin to boost their highs.

Addicts tend to rely on heroin only when they can no longer afford to buy opioids but are still desperate to feed their habit and so stave off “ dope sickness .” (Its wrenching withdrawal symptoms include nausea, chills, and diarrhea, as well as extreme anxiety and panic attacks.) Heroin dealers charge a fraction per fix of what illicit suppliers of the popular oxycodone – and hydrocodone -based analgesics demand per pill.

Consider Oxycontin. An 80-milligram pill costs about $6.00 at a pharmacy, but as much as $80 on the street. Compare that to the $15-$20 that will get you a hit of heroin. The price difference matters. Many opioid addicts end up putting the bulk of their earnings into purchasing the pills illegally, depleting their savings accounts. As a result, some end up resorting to selling personal possessions or even stolen machinery parts, piping, and copper wiring (for which there’s a large black market).

Unfortunately, even the 49,068 deaths in 2017 don’t provide the full picture. Additional fatalities result from combining painkillers with cocaine (4,184) or benzodiazepines (roughly 9,000). Add those into the mix and the total number of lives lost to the epidemic in this country reached 62,252 in 2017, the last year for which we have complete data. That figure soars higher yet if you include the nearly 16,000 deaths resulting from heroin.

To put the total number of opioid-related fatalities in perspective consider this: Vehicular accidents killed 40,100 people in 2017. The decade-long Vietnam War resulted in 58,220 American deaths. More than five times as many Americans died from opioid-powered painkillers in 2017 alone as in the 9/11 attacks and the wars in Iraq and Afghanistan combined.

As for the economic consequences, a 2017 report by the president’s Council of Economic Advisors pegged the total costs of the crisis, including medical services, lost earnings and productivity, and law enforcement, at $504 billion in 2015.

In other words, unlike what’s happening on the southern border, this isn’t a faux emergency.

The Pathway to Crisis

In nineteenth-century America, opiates were widely prescribed to treat many afflictions: pain from wounds or injuries sustained by Civil War veterans, menstrual cramps, asthma, anxiety, even babies’ teething pains. But as doctors became more aware of a growing wave of addiction, the federal government imposed restrictive regulations on such medicines, culminating in the 1914 Harrison Narcotics Act .

Though that legislation didn’t fully stamp out opiate use, it did mark a turning point. Medical opinion would not revert to a favorable view of such drugs until the 1970s, after which numerous opioid painkillers hit the market. The Federal Drug Administration (FDA) approved Lortab in 1982 , Vicodin in 1983 , MS Contin in 1987 , and Percocet in 1999 . Fentanyl was first introduced in 1959 and its skin patch variant received official approval in 1990 for the treatment of acute pain.

The current epidemic didn’t start revving up until Purdue Pharma, owned by the Sackler family, developed Oxycontin, an oxycodone-based painkiller. Following FDA approval in December 1996 , it became available, in varying strengths ranging from 10 to 160 milligrams. Compared to previous opioid treatments, Oxycontin was in a league of its own when it came to its potency. Doctors quickly started prescribing it, not a few with stunning abandon: In one instance 335,000 prescriptions over eight years. Within five years of its appearance, prescriptions had skyrocketed from 670,000 to 6.2 million.

Purdue claimed that Oxy, as it came to be known, was special and better than its predecessors because it worked through an extended, 12-hour time release, which would effectively eliminate addiction: The drug would neither provide a quick high nor have to be taken as often. In fact, the drug’s efficacy often petered out well short of the touted timespan. Purdue became aware of this but stuck to its claim.

By 2001, Oxycontin sales surpassed $1 billion a year. The boom was not spontaneous, but owed much to Purdue’s zealous product promotion. An army of sales representatives, deployed after being trained to convince doctors of the drug’s safety and efficacy, often offered those same doctors free meals, holiday gifts, trinkets, junkets, and more. Those sales agents did not lack for incentive; they received hefty bonuses pegged to their success . Top performers raked in more than their annual salaries in extra cash.

Purdue also trained thousands of doctors, nurses, and pharmacists at numerous conclaves in beautiful venues—all organized and paid for by the company—to spread the word that Oxy was effective and safe, not […]

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