Four years ago, 82.5 opioid prescriptions were written for every 100 persons in the United States, according to a database analysis by the Centers for Disease Control and Prevention (CDC). One year later, the Food and Drug Administration officials stated that they were “extremely concerned” about the opioid epidemic in the U.S. Overdose deaths related to opioids continued to increase, prompting the FDA to issue a call to action on the matter in 2014.
The 2014 call to action aimed to approve abuse-deterrent formulations, prevent excessive prescribing, improve insufficient prescriber and patient education, and encourage the development of non-opioid pain relievers. That plan must not have been executed or failed to work because another “call to action” to review opioid policy was issued in February 2016.
On Feb. 4, 2016, the FDA released an action plan fact sheet that outlines “concrete steps toward reducing the impact of opioid abuse on American families and communities” that the FDA plans to take. To accomplish this goal, the plan is to use many of the same strategies as the 2014 call to action, as well as to increase public access to the overdose emergency medication naloxone.
Opium is not a new drug. It has been around for thousands of years and its effects on humans are well-known to anyone who studies history. Long-term use results in tolerance, a phenomenon in which higher and higher doses are needed to achieve the same effect that low doses achieved in the short term. With long-term opioid use, pain control no longer becomes possible at nonlethal doses, and opioids need to be taken just to alleviate withdrawal symptoms.
Yet, scientists and others still claim that a way to safely use long-term opioids will eventually emerge. In the meantime, Americans are dying at an alarming rate. Even President Barack Obama recently addressed the problem, except his proposed solution was to decrease the demand for opioids by increasing access to treatment and such, rather than eliminating the supply itself.
In March 2016, the CDC executed one aspect of the FDA’s plan by issuing the “CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.” These guidelines actually do address the problem at the level of supply by urging physicians to avoid prescribing opioids for chronic pain. While the guidelines may help reduce the number of opioid prescriptions being written, it may also cause patients who are already opioid-dependent to turn to heroin.
Perhaps other government agencies need to follow the FDA’s example and plan some action to reduce the opioid supply. While drug users are criminalized and placed in prison labor programs, drug manufacturers and traffickers seem to enjoy impunity. The vast majority of drug arrests are for possession rather than sale or manufacturing, while the vast majority of presidential pardons go to drug traffickers. Taxpayers fund massive government surveillance programs with ample capabilities, yet still must live with dangerous drugs in their communities.
Recent trends in heroin use show that many people turn to heroin when they can no longer afford or obtain a prescription for painkillers. Seventy-five percent of heroin users in a recent study began their addictions through opioid painkillers. While the FDA’s plan includes increasing access to the emergency medication naloxone to treat narcotic overdoses, no agency has announced a plan to prevent the likely increase in heroin use as a result of restricted access to prescription painkillers.
The Chinese people triumphed over opium when it was brought into China as a weapon of war. Perhaps learning from their experience might help U.S. citizens resist the temptation to use opioids, regardless of whether they come from a drug dealer or their family physician. Doing so might lead to more effective steps that the public can take to win this horrific war. Staying clean, sober and informed is the only way to fight back and help others to do the same.
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About the author
Dana Connolly, Ph.D., is a senior staff writer for the Sovereign Health Group, where she translates current research into practical information. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. The Sovereign Health Group is a health information resource and Dr. Connolly helps to ensure excellence in our model. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.