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Tuesday, June 27, 2017

Opioids, a Mass Killer We’re Meeting With a Shrug

About as many Americans are expected to die this year of drug overdoses as died in the Vietnam, Iraq and Afghanistan wars combined
Nicholas Kristof

Credit Dominick Reuter/Agence France-Presse — Getty Images


For more than 100 years, death rates have been dropping for Americans — but now, because of opioids, death rates are rising again. We as a nation are going backward, and drug overdoses are now the leading cause of death for Americans under 50.

“There’s no question that there’s an epidemic and that this is a national public health emergency,” Dr. Leana Wen, the health commissioner of Baltimore, told me. “The number of people overdosing is skyrocketing, and we have no indication that we’ve reached the peak.”

Yet our efforts to address this scourge are pathetic.

We responded to World War II with the storming of Normandy, and to Sputnik with our moon shot. Yet we answer this current national menace with … a Republican plan for health care that would deprive millions of insurance and lead to even more deaths!

More on President Trump’s fumbling of this problem in a moment. But it’s bizarre that Republicans should be complacent about opioids, because the toll is disproportionately in red states — and it affects everyone.

Mary Taylor, the Republican lieutenant governor of Ohio and now a candidate for governor, has acknowledged that both her sons, Joe and Michael, have struggled with opioid addiction, resulting in two overdoses at home, urgent calls for ambulances and failed drug rehab efforts. Good for her for speaking up.

It should be a national scandal that only 10 percent of Americans with opioid problems get treatment. This reflects our failed insistence on treating opioids as a criminal justice problem rather than as a public health crisis.

A Times investigation published this month estimated that more than 59,000 Americans died in 2016 of drug overdoses, in the largest annual jump in such deaths ever recorded in the U.S. One reason is the spread of fentanyl, a synthetic opioid that is cheap and potent, leading to overdoses.

Another bad omen: As a nation, we’re still hooked on prescription painkillers. Last year, there were more than 236 million prescriptions written for opioids in the United States — that’s about one bottle of opioids for every American adult.

Even with all that’s at stake, there are three reasons to doubt that Trump will confront the problem.

First, Trump and Republicans in Congress seem determined to repeal Obamacare, which provides for addiction treatment, and slash Medicaid. The Congressional Budget Office estimated that the G.O.P. House plan would result in an additional 23 million Americans being uninsured in a decade — and thus less able to get drug treatment. Other, more technical elements of the G.O.P. plan would also result in less treatment.

Second, Tom Price, the secretary of health and human services, last month seemed to belittle the medication treatments for opioid addiction that have the best record, and Attorney General Jeff Sessions still seems to think we can jail our way out of the problem.

Third, Trump’s main step has been to appoint Gov. Chris Christie of New Jersey to lead a task force to investigate opioid addiction. But we needn’t waste more time investigating, for we know what to do — and in any case Christie talks a good game but bungled the issue in his home state.

Among experts, there’s overwhelming evidence of what works best: medication in conjunction with counseling. This doesn’t succeed in every case, but it does reduce deaths and improve lives. It also saves public money, because a result is fewer emergency room visits and inpatient hospital stays. So the question isn’t whether we can afford treatment for all people fighting addiction, but whether we can afford not to provide it.

The bottom line is that we need a major national public health initiative to treat as many Americans abusing drugs as possible, with treatment based on science and evidence. We also need to understand that drug overdoses are symptoms of deeper malaise — “deaths of despair,” in the words of Anne Case and Angus Deaton of Princeton University, stemming from economic woes — and seek to address the underlying issues.

Above all, let’s show compassion. Addiction is a disease, like diabetes and high blood pressure. We would never tell diabetics to forget medication and watch their diets and exercise more — and we would be aghast if only 10 percent of diabetics were getting lifesaving treatment.

Innumerable people with addictions whom I’ve interviewed haunt me. One was a nurse who became dependent on prescription painkillers and was fired when she was caught stealing painkillers from a hospital. She became homeless and survived by providing sex to strangers in exchange for money or drugs.

She wept as she told me her story, for she was disgusted with what she had become — but we as a society should be disgusted by our own collective complacency, by our refusal to help hundreds of thousands of neighbors who are sick and desperate for help.