"The Forgotten Epidemic" A Documentary
Last Sunday evening, I watched the MSNBC special, The Forgotten Epidemic, a program billed as an exploration of the opioid crisis and the struggle to cope with it in the midst of the current pandemic. Because news coverage over recent months has understandably been dominated by the disasters of COVID-19—including its unimaginable death toll—I appreciated the effort to remind mainstream viewers that drug overdose deaths are spiraling out of control with so much unaddressed suffering.
Even though I cringe at the label “opioid epidemic”—simply because it mischaracterizes the current catastrophe and thus our grasp of the way out—I was hopeful that the two-hour documentary would provide some enlightenment, deepening the understanding of the current forces responsible for the still-rising number of fatal overdoses, and instilling the compassion needed to chip away at the stigma brought on by the relentless criminalization of those who suffer. But I was disheartened by the program’s focus on old news, and believe it fell short of clearing up any of the misunderstandings that get in the way of needed reform.
The show detailed the overprescribing of opioid pain relievers such as oxycodone, a phenomenon brought on twenty years ago when greed-driven pharmaceutical companies pushed their sales reps with quotas, lobbied lawmakers, and lied to doctors about the risks of addiction. Often referred to as the launch of the first wave of the crisis, the insidious wrongdoing of big-pharma is well known, yet dangerously oversimplified. It wasn’t mentioned that heroin addiction and its accompanying despair had ravaged inner-city minority communities for decades—an epidemic that wasn’t newsworthy, not until it hit white people who could be seen as victims rather than marginal.
Also not addressed and not widely understood, is that the onset of addiction among the recipients of these prescribed medications was only about 10 percent, and was even less for those without previous illicit drug use. Nevertheless, the harms were real. As the program did convey, the excess of prescribed pills (those that were unneeded and unused) wound up being diverted to the streets where non-medical users had easy, affordable access.
The documentary went on to cover the also well-known governmental crackdown on opioid prescribing, “But, it was too late,” Mr. O’Donnell explained. “Addicted people turned elsewhere and cartels rushed in to meet the need, with heroin.” While it wasn’t explicitly stated, one could infer that law enforcement’s sweeping tactics of manufacturing mandates and Prescription Drug Monitoring Programs (PDMP) prompted what is known as the second wave of the crisis.
On the surface, the punitive approach of law enforcement may seem logical. And some reductions made sense, such as ending the practice of automatically issuing a thirty-pill prescription for the sort of short-term pain that warrants only a dose or two. But not unlike the dogma behind the long-fought war on drugs, control and prohibition—rather than individual health and wellness—were the driving force. Outcomes that were not mentioned include:
Addicted individuals, without the benefit of health care or even concern for their plight, were forced into more dangerous markets with an unregulated drug supply, increasing crime, benefitting only the cartels, and bringing on an uptick in overdose fatalities.
Because doctors were given strict guidelines and threatened with criminal prosecution, thousands of chronic pain sufferers were forced off of their prescription drugs despite having done well with an established medication regime. Given that these were the last people with any unused medication that could have wound up on the streets, their prescriptions did not contribute to the epidemic. Even so, the crackdown swept them into the supposed solution, serving only to create a whole new set of victims. Unable to manage daily life with untreated suffering, these patients were frequently driven to black market drugs or suicide, adding to the fatalities.
The fact is, since 2012, massive time and resources have been dedicated, with a dogged determination, to ramping up complex monitoring systems involving pharmacies and insurance companies while undermining doctor-patient relationships and needed health care. Yes, opioid prescriptions have steadily plummeted, but the death toll has continued to rise, and dramatically so.
It was made clear that illicit drugs became more deadly as the highly lethal fentanyl entered the market (wave three), but there was no mention of the role that prohibition, and thus criminalization, played in this reality.
I was troubled too by the coverage of jail sentences for drug dealers as if it’s a foregone conclusion that these people are murderers. Street drugs are unregulated—they fluctuate in strength and additives. All one has to do is read the extraordinarily thorough research detailed in Ben Westhoff’s acclaimed book, Fentanyl, Inc., to understand that dealers (countless hands down the line from the shipments, which are themselves inconsistent, coming out of China) are usually unaware of the potency of the unlabeled drugs. Sadder still, many dealers are simply trying to support their own addiction and don’t see any other way out.
Drug courts were mentioned as a positive initiative, when in reality, the likely outcome is jail time or coerced treatment, often increasing the risk of overdose death upon release. There was a fleeting mention of Suboxone (an FDA approved drug proven to be highly successful in treating addiction) but it wasn't presented in a favorable light. The program concluded with a “no end in sight” message, at least instilling some cause for alarm.
But there are solutions, requiring, for starters, acknowledging that we’re on the wrong track. We need to take on an analysis of the cause of addiction, own up to the racist roots of the failed war on drugs, and face the reality that current policies aren’t working, clarified by the rise in overdose deaths in 2019, before the pandemic, and those of 2020—a year that will weigh in as the deadliest on record.
The majority of current deaths are the result of polydrug use with a spike in drugs such as cocaine and methamphetamine. This trend is on the rise, illustrating not only that the crisis goes beyond opioids, but also that it calls for a more nimble approach. If we could close the gap between science and policy, we would find a roadmap corroborated by years worth of medical research and published studies.
The American Medical Association 2020 report—physicians’ progress toward ending the nations’ drug overdose and death epidemic—highlights the evolution of a more complicated and increasingly dangerous crisis, one no longer fueled by prescription drugs and recognizes that the over-focus on PDMP has done more harm than good in routinely denying health care for both pain patients and those suffering from addiction.
Mirroring recent studies from researchers across the country including Yale University’s School of Medicine and The National Academies of Sciences Engineering and Medicine, the AMA urges policymakers to remove barriers to evidence-based care, to recognize the disparities faced by communities of color, to promote harm reduction services—including clean syringe programs and overdose prevention sites—and to eliminate punitive policies.
In all, this is a humanitarian crisis, and the criminal justice system’s continual tact of inflicting shame and punishment over health care is failing us. As stated by Dr. Patrice A. Harris, chair of the AMA Task Force, “Policymakers, health insurance companies, pharmacy chains must move beyond words; they must take meaningful action to remove barriers to evidence-based health care. We all need to work together, but the status quo is killing far too many of our loved ones and wreaking havoc in our communities.”
How many more preventable deaths will it take to inspire a collective effort? While saving lives is first and foremost, educating members of society is crucial to derailing the stigma, something that is needed to motivate those who can make a difference to do so.
[photo credit: Alistair MacRobert]