Ithaca, Opioids, and Trump

Ithaca and Tompkins County are among the American localities severely affected by the opioid crisis, prompting intensified efforts by local officials. Overdoses are a common occurrence, and authorities report an average of 15 drug-related deaths a year since 2011. In 2016, the number skyrocketed to 21, compared to two deaths in 2007.

President Trump put a welcome spotlight on the opioid crisis this week, declaring it a “public health emergency” and describing it as a plague that has spared “no part of our society, not young or old, rich or poor, urban or rural.” At least 64,000 Americans died of overdoes in 2016, driven, Trump said, “by a massive increase in addiction to prescription painkillers, heroin, and other opioids.”

ithacavoice

Trump said he was “directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis,” but was short on specifics, mainly rattling off various steps that the federal government had previously taken.

Moreover, Trump’s diagnosis of the crisis and prescription for its cure seemed wide of the mark. His speech focused on blaming foreigners—Chinese and Mexicans—for sending illicit opioids into the country, and on criminal gangs for pushing them on America’s streets. (A key part of Trump’s future plan, he said, is a “massive advertising campaign to get people, especially children, not to want to take drugs in the first place.”)

Trump made no mention of two factors that experts increasingly see as fueling the addiction epidemic—pharmaceutical companies pushing legal opioids, and a national mental health crisis in which people desperately seeking relief from depression and anxiety find relief in opioids.

The Atlantic’s Alana Semuels reported in June:

“Ohio’s Attorney General Mike DeWine filed a lawsuit Wednesday against a handful of pharmaceutical companies, including Purdue Pharma, Teva Pharmaceuticals, and Johnson & Johnson. The lawsuit accuses the companies of spending millions on marketing campaigns that ‘trivialize the risks of opioids while overstating the benefits of using them for chronic pain.’ The companies, the lawsuit alleges, lobbied doctors to influence their opinions about the safety of opioids, ‘borrowing a page from Big Tobacco.’

“The lawsuit follows similar recent lawsuits in Illinois, Mississippi, four counties in New York, and Santa Clara and Orange Counties in California. Last month, the Cherokee Nation filed a lawsuit against distributors and pharmacies in tribal court over the opioid epidemic. In January, the city of Everett, Washington, filed a lawsuit against Purdue Pharma, the makers of OxyContin, alleging that the company knew the drug was being funneled into the black market but did nothing to stop it.”

Also in June, the Washington Post’s Lenny Bernstein reported on a study by researchers at the Dartmouth-Hitchcock Medical Center and the University of Michigan that linked greater opioid use and mental health disorders. The researchers concluded that 51.4 percent of 115 million opioid prescriptions written annually in the United States were given to people with anxiety and depression.

“Those patients may have some form of physical pain, said Brian Sites, a professor of anesthesiology and orthopedics at Dartmouth’s Geisel School of Medicine, who led the study team. But their mental condition may cause them to feel that pain more acutely or be less able to cope with it, leading to increased requests for something to dull it.

“Pain that ‘you may report as a two out of 10, someone with mental health disorders — depression, anxiety — may report as a 10 out of 10,’ Sites said in an interview. In addition, opioids may improve the symptoms of depression for a short while, he said, with patients who experience that then asking for continued refills.

“As a result, doctors trying to be empathetic to their patients’ complaints may tend to overprescribe opioid painkillers, he said. About half of all opioids are prescribed by primary-care physicians, who also manage most routine anxiety and depression.”

Trump’s declaration of a “public health emergency” did not involve the release of emergency federal funding, but the White House indicated that the president would soon ask Congress for additional funding to combat the opioid crisis. Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, chaired by Governor Chris Christie of New Jersey, will hand Trump its final report and recommendations next week.

The New York Times quoted experts saying that an effective policy to fight the crisis will cost billions of dollars:

“Andrew Kolodny, the co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University, said that no emergency declaration would do much to alleviate the impact of opioids without a substantial commitment of federal money and a clear strategy for overhauling the way the country treats addiction.

“‘What we need is for the president to seek an appropriation from Congress, I believe in the billions, so that we can rapidly expand access for effective outpatient opioid addiction treatments,’ Dr. Kolodny said in an interview. ‘Until those treatments are easier to access than heroin or fentanyl, overdose deaths will remain at record-high levels.’”

Senator Joe Manchin of West Virginia, a state hard hit by the opioid crisis that Trump singled out in his remarks, called for pharmaceutical companies to pay. CNN reported:

“‘This is a business plan. They are liable,’ Manchin told CNN’s Jake Tapper on ‘The Lead’ when asked if he believes the pharmaceutical industry needs to be found legally liable in some cases for the prevalence of opioids in the United States.

“Manchin added that the companies that supply opioids should be charged fees for the drugs they produce and for having inundated the market with the highly addictive drugs.

“‘This is what’s caused it. Can’t we at least charge the pharmaceutical companies one penny per milligram for every opiate they produce?’ Manchin added.

“‘Every state’s been affected,’ he said of the crisis. ‘I’m ground zero, West Virginia, more deaths per capita, more people addicted per capita.’

“‘This is like fighting a war,’ Manchin said about the need for funding. ‘You’ve got your soldiers on the front line fighting … (but) your guys on the front line run out of bullets.’”

Chart: From the Ithaca Voice, October 13, 2017