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Trump Plan to Combat Opioids Misses the Primary Driver of Addiction

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There's a misunderstanding of what is driving this crisis.

Narcan, an antidote to opioid drug overdoses, has saved many lives. Equipping law enforcement agents and first responders to carry it while on duty is one prong of President Trump's new Initiative to Stop Opioid Abuse, announced Monday in New Hampshire.

The plan also calls for tougher punishment of drug dealers — perhaps even the death penalty for some crimes, an idea that the president's critics and civil rights advocates say is a step too far.

But even more problematic may be the president's proposal to reduce opioid prescriptions written by doctors — and to keep track of patient requests for prescriptions in a federal database.

The "Safer Prescribing Plan" aims to cut opioid prescriptions by one-third within three years.

Reducing the abuse of opioids is a worthwhile goal, but as addiction specialist Sally Satel explains, the problem does not lie with legitimate opioid prescriptions.

I have ... watched a false narrative about this crisis blossom into conventional wisdom: The myth that the epidemic is driven by patients becoming addicted to doctor-prescribed opioids, or painkillers like hydrocodone (e.g., Vicodin) and oxycodone (e.g., Percocet). One oft-quoted physician refers to opioid medication as “heroin pills.” This myth is now a media staple and a plank in nationwide litigation against drugmakers.

The amount of opioid prescriptions did rise from the mid-1990s to 2011, but only a very small minority of patients prescribed drugs like Vicodin end up hooked. Satel says the true source of the overdose epidemic comes from a source other than the doctor’s office.

I have studied multiple surveys and reviews of the data, which show that only a minority of people who are prescribed opioids for pain become addicted to them, and those who do become addicted and who die from painkiller overdoses tend to obtain these medications from sources other than their own physicians. Within the past several years, overdose deaths are overwhelmingly attributable not to prescription opioids but to illicit Fentanyl and heroin. These “street opioids” have become the engine of the opioid crisis in its current, most lethal form.

True, many doctors have written prescriptions too large for their patients’ actual needs, and that leads to more drugs on the street.

[M]illions of unused pills end up being scavenged from medicine chests, sold or given away by patients themselves, accumulated by dealers and then sold to new users for about $1 per milligram. As more prescribed pills are diverted, opportunities arise for nonpatients to obtain them, abuse them, get addicted to them and die.

The black market supply of formerly legitimate prescriptions can be curbed by more accurate prescription writing. Safe use initiatives are already in place, but the legitimate use and prescription of opioids is not the source of the epidemic.

The more dangerous and widespread use of heroin and Fentanyl are the source of the growth in abuse and addiction. Creating a database of patients using prescriptions is unlikely to curb the demand for illicit opioids. The wrong solutions will likely make the problem worse.

Do you know someone who has been hit by the opioid crisis? What are your thoughts on these proposals? Share your insights with us!

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