For the first time in over 50 years, U.S. life expectancy has decreased for the second consecutive year. This decline is in part due to the drastic rise in opioid-related deaths, which increased by 21% in 2017 (1). More than 33,000 people died from opioid-related overdoses in 2015. From 1999 to 2015, more than 183,000 people died from prescription opioid overdoses (2). Prescriptions written for opioids quadrupled from 1999 to 2010. Despite this increase in prescriptions, Americans did not report an increase in the amount of reported pain during this time (3).
Many attempts have been made to curb the opioid epidemic, ranging from greater distribution of opioid substitution therapies (such as methadone) to better access to the opioid-reversal drug naloxone. One such attempt has been under particular scrutiny given its questionable efficacy and its human rights violations: compulsory drug treatment.
Compulsory drug treatment involves inpatient or outpatient centers where patients are mandated by court order to engage in drug abstinence and engage in various forms of therapy. Compulsory treatment, exclusively abstinence-based, happens both within the criminal justice and civil systems, through drug courts and civil commitment laws. While drug abstinence may seem beneficial in theory, a recent meta-analysis has shown that existing compulsory drug treatment programs are not beneficial and may in fact increase the rates of recidivism (4). Moreover, compulsory drug treatment, whether through drug courts or involuntary commitment, calls into question a violation of individuals' fundamental rights, specifically the rights to bodily integrity and health (5).
Encourage the expansion of harm reduction programs. An alternative to compulsory drug treatments is the notion of harm reduction, which encourages safe needle use, implementation of opioid substitution therapies, and community and peer advocacy. Evidence shows that harm reduction programs helped with thousands of life-saving naloxone reversals (6). Learn more and help out here, and check out the LEAD (Law Enforcement-Assisted Diversion) harm reduction program here.
Call on your local and federal policymakers to increase regulations on opioid prescriptions and ensure transparency regarding their addictive potential. In 2016, the FDA mandated black box warnings for opioids given their life-threatening risks and addictive potential (7). However, many pharmaceutical companies continue to deflect responsibility for understating their drugs’ addictive potential, and spent almost $900 million on lobbying from 2006 to 2015 (8). At the same time, we must ensure that opioids remain available for those patients who truly need them, particularly patients receiving palliative care.
Call on your local and federal policymakers to support bill HR 994. This bill requires the Government Accountability Office to report on inpatient and outpatient treatment capacity, availability, and needs, including detoxification programs, clinical stabilization programs, transitional residential support services, rehabilitation programs, treatment programs for pregnant women or adolescents, and treatment through Indian health programs. This would allow resources to be best allocated towards harm reduction efforts.
Hold health care providers accountable. Health care professionals are often the gatekeepers when it comes to access to opioids. Health care providers need to be aware of the risks surrounding opioids, with the understanding that they are still appropriate for certain patients. Medical, physician assistant, and nursing students should be trained on pain management, addiction prevention and treatment strategies, and effective administration of naloxone.