It’s Too Early to Celebrate ‘Progress’ on the Opioid Epidemic

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Secretary of Health and Human Services Alex Azar and the Trump administration say they’re winning against opioids, but the drug epidemic is as fatal and far-reaching as ever—and the recent, small wins reported in a national survey on drug use likely have nothing to do with the White House. Instead of taking credit for “progress,” Trump needs to treat the drug epidemic like the public health emergency he said it was almost a year ago. We need a plan to save lives, not a participation trophy.

The National Survey on Drug Use and Health (NSDUH), released on Friday, showed that the number of people trying heroin for the first time has fallen by more than 50 percent from 2016 to 2017, and that 3 percent more people are seeking opioid-specific treatment. The administration is saying that’s a win, but it barely scratches the surface of our national health crisis. According to the Centers for Disease Control and Prevention, 8,400 more Americans died from drug overdoses in 2017 than died in 2016—leaving a total of 72,000 dead last year. According to the Surgeon General’s 2016 report on addiction, 90 percent of people never get medical care of any kind for their substance problem. Bringing that number down by three percent is not a success.

Azar wrote an op-ed on Wednesday claiming that “dedicated efforts from the federal government on down to local governments, faith communities, families, and individuals are working. Since President Trump took office, we have seen a 264 percent increase in the prescribing of [overdose antidote] naloxone, and a 16 percent increase in the prescribing of one form of addiction treatment.” Azar added that fewer Americans are using opioids, as well.

But America doesn’t have a heroin problem, or even an opioids problem—it has an addiction problem. People don’t die because they got a “bad batch” of heroin. That may be the last thing that happened before their death, but what really killed them is the fact that we don’t invest in effective prevention, recovery supports, sober living, qualified behavioral healthcare, and consistent, compassionate care for substance use disorder.

For example, the Senate recently passed a sweeping opioids package with strong bipartisan support, but the $7 billion to $10 billion that Trump is committing to fight opioids isn’t enough. Sarah Wakeman, the medical director for Massachusetts General Hospital’s Substance Use Disorders Initiative, told the Washington Post that truly tackling the opioid epidemic would require federal funding on par with the more than $20 billion a year spent on HIV/AIDS. Underfunding or ignoring the programs and reforms created by that legislation will not do enough to save lives. That’s not a win. Every overdose is a loss.

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I asked Andrew Kolodny, co-director of opioid policy research at the Heller School of Brandeis University and co-founder of Physicians for Responsible Opioid Prescribing, to comment on the report of a decline in first-time heroin users. He says it was more likely caused by an increase in perceived risk rather than any specific steps taken by the federal government.

Other positive trends, like reductions in overdose deaths involving prescription opioids, are more likely a result of slight improvements in prescribing practices. "It's not clear the Trump administration deserves credit for this," Kolodny says. And since overdose deaths overall are increasing, there may be a dark side, too: The CDC says that while prescription drug deaths are falling, more people are dying due to synthetic opioids like fentanyl.

For people who don’t understand how the drug epidemic works, these small inflections—fewer people trying heroin, more overdose meds being prescribed—might look like wins. But for those of us who work on the front lines as advocates, first responders, law enforcement, and families, it’s nothing to celebrate. The bigger picture hasn’t changed. Prescription drugs, not heroin, are still the gateway to opioid addiction and chronic use.

Throwing pennies at an opioid-specific agenda that’s more focused on an acute crisis response is not an effective way to address a national addiction epidemic that affects people who have substance use disorders that aren’t opioid-specific—disorders involving alcohol, cocaine, methamphetamines, or benzodiazepines like Xanax. Addiction is a spectrum disorder. It doesn’t discriminate between substances. It affects people from all backgrounds, income levels, professions, and regions. Focusing exclusively on opioids creates a massive blind spot in our government’s approach to addiction, and it can end up costing more lives. People fall into the gaps, and they don’t make it out.

There’s no doubt that America has a substance use problem. The NSDUH gives us part of the picture, but there is so much more to this public health crisis than pills and prescriptions. We need to keep our eyes and minds open and focused on recovery—not on substances or short-term, emergency solutions.

On the point that the new report is only part of the picture: The study states in a footnote that “Because NSDUH respondents were asked about the misuse of only prescription forms of fentanyl, however, this estimate for fentanyl misuse may under-represent people who misused fentanyl that was illicitly manufactured in clandestine laboratories.” When people make a hard distinction between illicit opioids and FDA-approved drugs, or say that more opioid treatment medications (like buprenorphine) is the answer, my spider-senses start to kick in.

Prescriptions such as buprenorphine are highly effective for opioid use disorder. However, their success is usually dependent on effective, wraparound behavioral healthcare services and stable recovery supports including housing. There is no silver bullet or magic pill that will be the cure-all to addiction.

Azar is a former drug company executive and former director of a pharmaceutical lobby, so it makes sense that he measures “success” in new prescriptions for overdose reversal drugs and opioid treatment meds. But we can’t look at the drug epidemic that way. We can’t prescribe our way out of the this problem. Pharma got us into this mess, and made billions of dollars off highly addictive, lethal painkillers. More prescriptions cannot be the only answer. We need accountability, and a radical overhauling of the systems that make people sick—and that make money from keeping them that way.

One of the biggest lies Big Pharma has sold us is that opioids manufactured by American pharmaceutical companies are somehow less dangerous, less addictive, and less lethal than the drugs made illicitly or in other countries. Top-shelf vodka is just as toxic as homemade moonshine, and fentanyl that was smuggled into the United States from a lab in China can be just as lethal as some of the stuff you get at the pharmacy counter. Millions of people have died because Big Pharma, Big Tobacco, and Big Alcohol keep telling us that their products are somehow less dangerous than street dope.

It doesn’t matter where the drug came from—the person, not the substance, must be the focus if we’re going to help people recover. We need a recovery model and funding that isn’t just centered on treatment, and data that measures “success” in healthy days and sustained recovery, not programs completed or prescriptions written.

NSDUH’s data is sound. But the White House is quick to claim a win on the Trump opioids agenda when they’re actually just moving the goalposts. I’m not saying it’s bad that more people are receiving treatment for their opioid addiction—that’s good news, the silver lining in the report. But are we providing the continuing supports that promote sustained recovery beyond the treatment phase? Probably not. Our country’s recovery infrastructure is vastly underfunded to a point of almost being completely ignored. Treatment is not recovery. The sooner we can grasp that fact, the more lives we will save.

We need to incentivize recovery, for people and for providers. We need to keep sharing our experiences—and demanding reform. We must push for more choices when it comes to funding recovery. And we must remain at the forefront of this national conversation.

This crisis will not be solved in one administration, one budget, or one Congress. But we’ll get there a lot quicker if we keep those making decisions about us accountable and educated.

We don’t have the luxury of a victory lap.

Ryan Hampton is a person in recovery from heroin addiction and author of American Fix: Inside the Opioid Addiction Crisis—and How to End It published by St. Martin’s Press. He’s a nationally recognized activist and founder of the nonprofit advocacy organization The Voices Project.

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