Sanders's proposed opioid legislation is too focused on the past

Sanders's proposed opioid legislation is too focused on the past
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This week, Sen. Bernie SandersBernie SandersHickenlooper day-old Senate bid faces pushback from progressives Steyer calls on DNC to expand polling criteria for debates Andrew Yang: News coverage of Trump a 'microcosm' of issues facing country MORE (I-Vt.) released proposed legislation that would restrict the activities of companies that manufacture and distribute opioid pain medications. While these commonsense measures would have some impact, they respond to a problem that is largely in the past. And by themselves, they profoundly fail to address the current opioid epidemic and meaningfully curtail its impact.

Sanders’s bill would prevent manufacturers from marketing opioid drugs directly to consumers as non-addictive. The legislation, termed the Opioid Crisis Accountability Act, also limits the quantity of opioids that wholesalers can distribute in a single community.

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Restrictions on misleading opioid drug advertising would have been a very helpful measure 15 years ago. But for the most part, we haven’t seen that sort of marketing in more than a decade. Meanwhile, simply limiting delivery of prescription medications will do little to fix the demand side of the equation.

 

Aggressive marketing by pharmaceutical manufacturers — the main target of the Opioid Accountability Act — clearly helped create our current opioid crisis. According to Dr. Nora Volkow, director of the National Institute on Drug Abuse, it is one of three major factors that led to the opioid epidemic, along with greatly increased prescribing of pharmaceuticals overall and opioid pain medications in particular and increasing social acceptability of using medications.

In the 1990s, physicians and other prescribers were bombarded with messages about under treatment of chronic non-cancer pain and about the safety of using opioid pain medications for this purpose. Pharmaceutical companies marketed directly to patients and physicians describing their products as safe and effective.

They described as quite low the likelihood of chronic pain sufferers developing opioid addiction, now also called opioid use disorder. Clinical practice guidelines emphasized the need for more aggressive treatment and professional societies also endorsed these policies. Doctors who were not routinely providing pain medications were made to feel that they were not serving their patients well.

As Sen. Sanders notes, pharmaceutical manufacturers reaped tremendous profits selling brand-name opioid products while directly contributing to causing the opioid epidemic. For example, Purdue Pharma made a $22 billion profit in selling OxyContin in the last decade, Sanders says.

Oxycontin was touted as less addictive and less subject to abuse than other prescription opioid pain medications, despite no legitimate research to back up those messages. In 2007, Purdue and three of its executives plead guilty to misleading the public about the drug’s risk for addiction and agreed to pay more than $600 million — a substantial penalty, but a tiny fraction of the profits made selling Oxycontin.

Because pharmaceutical companies played a direct role in helping to create this crisis, numerous states, including my own state of North Carolina, have sued pharmaceutical manufacturers to recoup some of the direct costs related to opioid addiction, including medical care and incarceration.

Mainly, though, the staggering costs of the opioid epidemic have been born by taxpayers, individuals and families who have suffered grave losses and organizations who pay for medical insurance. According to the Council of Economic Advisors, the opioid epidemic cost our country more than $500 billion in 2015 alone in health care costs, lost economic productivity, the value of lives lost due to opioid overdose deaths and costs to the criminal justice system.

Sen. Sanders is right to hold pharmaceutical companies accountable for misleading direct-to-consumer advertising around the safety of opioid drugs. Sadly, though, this legislation addresses an historical factor instead of engaging today’s rapidly changing opioid epidemic.

Right now, far more individuals are dying from illicit opioid drug use than prescription pain pills. For example, in North Carolina, heroin and fentanyl contributed to 17.5 percent of opioid overdoses in 2010. By 2017, heroin and fentanyl played a role in 78.1 percent of opioid overdoses. Sen. Sanders’s home state of Vermont has been particularly hard hit by illicit drug use.

What we need now are better strategies for treating people who are battling addiction to illegal drugs. Our government should fund evidence-based treatments for opioid use disorder, including proven medical therapies such as methadone, buprenorphine (commonly prescribed as suboxone) and naltrexone and counseling.

These proven approaches should be made more readily available in private practices, community health centers and larger health care systems. Currently, too few providers offer effective opioid treatments. Many providers also won’t accept Medicaid or Medicare and do not provide care to uninsured patients who lack the ability to pay.

We should also take a hard look those in the federal prison system on drug-related charges. Cruelly, about 90 percent of these individuals receive no treatment for their addiction while incarcerated. When released, they often return to an environment where the drugs are much stronger due to the higher purity of heroin, now often mixed with fentanyl. Stronger drugs, in turn, increase the risk of death by overdose.

Prescription opioids still play a role in the opioid epidemic, particularly for young people tempted to misuse family members’ prescription drugs. But more and more, it is illicit opioids that are killing Americans and costing our society billions. Heroin in particular has achieved a level of purity and potency never seen before in this country. And it is now peddled using highly efficient delivery, at lower costs.

Our government should not focus on fighting past causes of this complex problem. Instead, we should slow the flow of imported illicit drugs and punish those who profit from selling them. We must better educate the public about the staggering risk of experimenting with opioids. And finally, we must do a better job treating those who are in the grip of opioid addiction. The cost of ignoring this epidemic is simply too high.

Lawrence Greenblatt, M.D. is co-chair of the Opioid Safety Committee at Duke Health and chairs the North Carolina Medicaid Pharmacy and Therapeutics Committee.