The widespread devastation of the opioid crisis becomes clearer with each new report. Nationwide, opioids have helped increase mortality rates for the first time this century, and drug overdoses are now the leading cause of death for Americans under 50. In Florida, during the first six months of 2016, opioids killed an average of 14 people every day. Only a comprehensive, aggressive response coordinated by the federal and state governments will start to reverse the drug epidemic that is ravaging families and communities.
Led by Attorney General Pam Bondi, Florida aggressively cracked down on the pill mill crisis that peaked in 2010. Tougher penalties for pill mill operators and better oversight of prescription drugs were effective measures that helped reverse the trend. But cracking down on one area of drug abuse created unintended consequences, as addicts who relied on pill mills turned to stronger opioids available on the streets, such as heroin and fentanyl. In 2010, eight people in Florida were dying every day on average from opioids. For the first half of 2016, that average nearly doubled. The broad trend is the same nationally, as the Centers for Disease Control and Prevention reported last week that prescriptions for opioids declined between 2012 and 2015 as the overall death rate from drugs such as heroin and fentanyl rose much faster.
State officials are on the case. Gov. Rick Scott extended his declaration of a public health emergency to distribute $27 million in federal money for various treatment and prevention programs, including $17.8 million for medication-assisted treatment and related counseling. A three-year minimum sentence for people caught with 4 grams of fentanyl or carfentanyl approved by the Legislature this spring and signed into law by Scott should be another deterrent to dealers. The $10.5 million in state money allocated by Tallahassee to reduce opioid dependency will help as well.
Two announcements from the federal government last week also represent progress in the fight against opioids. The Food and Drug Administration said it will require drug manufacturers to better educate physicians about the painkillers. And the Justice Department announced a $35 million settlement with Mallinckrodt Pharmaceuticals, a company charged with looking the other way when it had reason to believe its opioids were on the black market.
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If the tide of the epidemic has not been turned, the battle at least is joined. Governments at all levels are becoming increasingly aggressive against drug dealers, manufacturers and the insurance companies that limit treatment for substance abuse. States have sued drug companies, alleging they fueled the epidemic by underplaying or misrepresenting the drugs’ danger.
Pharmaceutical companies should regard the Justice Department’s settlement with Mallinckrodt as a shot across the bow. The agreement, described as the first with a manufacturer tied to the opioid crisis, carried more than a stiff financial cost. It requires the company to begin tracking its drugs as they move through the supply chain into the hands of consumers. That obligation, if required of other manufacturers and suppliers as well, should help to dampen what seems to be a free flow of drugs.
Physicians represent another potential choke point. If people aren’t prescribed opioids, they can’t become addicted and move on to related drugs, such as heroin.
The FDA already requires drugmakers to provide training to physicians about extended-release opioids. Now, they’ll have to offer the training about fast-acting opioids, too, and provide information about pain management and non-drug therapies (some of the same ones that Shapiro wants insurance companies to cover). Physicians don’t have to accept the training, but they should. One wonders why physicians don’t learn enough about the dangers of opioids in medical school. Addiction is not a moral failing. The failing would be if government and other parties did not marshal all available resources against the scourge. Increasingly, we are seeing what Shapiro has called a “multidisciplinary approach.”
Strong federal support is the essential element in making massive changes, and President Donald Trump promised in March “to help those who have become so badly addicted.’’ Yet Washington has failed to deliver. The Republican legislation to repeal and replace the Affordable Care Act would weaken efforts to fight opioid abuse, particularly by reducing federal money that would be spent for Medicaid. A proposal to add $45 billion in the next decade to fight opioids in the Senate bill pales in comparison to the $772 billion in overall Medicaid reductions it would make by 2026. Grant money has to complement health coverage, not substitute it.
To effectively combat this crisis will require a more aggressive and holistic response — and not just on the punishment side. The critical step is greatly expanding treatment and prevention resources to help addicts. That requires long-term care, counseling and oversight that hospitals and treatment centers across the state simply do not have the capacity or financial resources to provide now. Florida and other states cannot reverse the tide by themselves, and the president and Congress need to step up with a real commitment of money and resources.
Versions of this editorial first appeared in the Tampa Bay Times and the Pittsburgh Post-Gazette.