Limiting Patient Access Is a Marginal Fix to the Rate of Overdose Deaths
At an event in New Hampshire, President Trump announced a multi-step approach to dealing with America's opioid overdoses crisis. Among those plans is a proposal to equip more first responders with Narcan, a life-saving antidote to opioid overdoses. The plan also includes the controversial idea of more severely punishing drug dealers all the way up to the death penalty.
Trump aims to cut overdoses, but ultimately targets the wrong source.
The primary driver of opioid addiction is not legitimate prescription use, but accessibility of illicit street drugs like heroin and fentanyl. However, the White House's plan will crack down on legitimate prescriptions over a period of three years, with the goal being to reduce the number of opioid prescriptions by one-third.
It sounds like a good idea on the surface, but as addiction psychologist Sally Satel and physician Stefan Kertesz write, this plan will only cause more problems than already exist, especially for those who rely upon opioid painkillers for relief from chronic pain.
The undeniable reality is that prescription pills (often mixed with other drugs) do produce fatalities, sometimes in patients who receive them as part of medical care. Nonetheless, about three-quarters of the roughly 42,000 opioid-related overdose deaths in 2016 were caused by heroin and illicit fentanyl. Deaths associated with commonly prescribed opioids (in cases where there is no heroin and fentanyl present) have fallen only slightly since 2011 (from 10,346 to 9,688 in 2016, a figure that includes typical pain medications but not methadone), despite a 48 percent reduction in high-dose opioid prescriptions since that time. These realities challenge the assumption that prescription control will have a big impact on the overall toll of opioid deaths. Meanwhile, anyone with a conscience has to ask what will happen to patients whose medications for pain are reduced in order to meet a presidential mandate of one-third by three years.