In “Chasing the Scream: The First and Last Days of the War on Drugs,” and in a viral TED talk, journalist Johann Hari explains how, for nearly a century, we’ve battled addiction by punishing and shaming both dealers and people suffering from addiction.
In the United States, approaches to opioid addiction focused on a “war” on drugs, targeting not only traffickers of illicit drugs, but also those with substance-use disorder who commit minor drug crimes. This, along with measures tightening restrictions on opioid prescriptions for chronic pain, has failed to stem the climbing overdose death rate.
Clearly, punitive strategies are failing. The good news is that we’re beginning to turn the corner toward a more enlightened opioid policy.
The changes could not be more timely. 2017 was the deadliest year on record for opioid fatalities. According to data from the Centers for Disease Control and Prevention, more than 70,000 Americans died of a drug overdose in 2017, 47,600 of them from opioids. Of those 70,000, 974 were West Virginians, making our state the hardest-hit in the country, on a per capita basis.
In October, however, the U.S. Senate took an important step toward a more enlightened opioid policy, voting 98-1 for legislation that’s part of the Support for Patients and Communities Act. The same month, President Donald Trump signed it.
The new law promotes several evidence-based opioid treatments and policies that an expert panel from the Institute of Medicine had recommended, making it easier for Medicare and Medicaid to pay for addiction treatment. It equips more first responders — EMS professionals, police officers and others — with the life-saving overdose-rescue drug naloxone. It creates a Federal Drug Administration fast-track to spur pharmaceutical companies to develop better non-opioid, non-addictive painkillers.
The bipartisan group of senators who developed the legislation, including Sen. Joe Manchin, D-W.Va., and Sen. Shelley Moore Capito, R-W.Va., deserve credit for helping shift federal policy toward better and smarter laws that focus on prevention and treatment.
Gov. Jim Justice also deserves praise, for establishing the Governor’s Council on Substance Abuse Prevention and Treatment, making sure substance-abuse experts from health professions are strongly represented. As a physician, native West Virginian and the senior officer of health and health care at West Virginia University, I’m pleased to serve on the council, which will work closely with Bob Hansen from Marshall University as the director of the state Office of Drug Control Policy to address this problem.
To reverse this devastating epidemic, we also need improved treatments for acute and chronic pain, a central driver of opioid use and subsequent abuse.
In November, for example, doctors at WVU’s Rockefeller Neuroscience Institute, under the leadership of Dr. Ali Rezai, implanted a tiny pellet the size of a grain of rice near a patient’s spine for the first time. The pellet will release steady and precise doses of a non-opioid drug called clonidine to combat chronic lower back pain — the cause of more lost work days than any other medical condition.
We’ll also need to look deeper at what’s driving the opioid crisis.
Punitive opioid policies have caused people to feel socially isolated, hopeless and in despair. This leads to chronic stress, which drives our fight-or-flight response through our sympathetic nervous system. In response, many turn to opioids to escape the emotional and resulting physical pain.
To overcome this vicious cycle, we need policies that foster purpose and human connection, powerful factors in cultivating personal resilience.
Low-paying and disappearing jobs fuel anxiety, and the chronic stress gets much worse if food is scarce and there’s little security at home. But decent-paying work that lets people contribute to the community can add purpose and ease stress.
In Portugal, an astounding 1 percent of the population was once addicted to heroin, and people suffering from addiction were shamed and punished. The Portuguese government created jobs and provided microloans to start small businesses. As individuals found purpose and reconnected with society, rates of injecting drug use and overdose plummeted.
It is just such an outcome that West Virginia University and its partners in WV Forward are hoping for in the multidimensional effort to improve opportunities and quality of life in the state.
My grandfather worked for years in the coal mines, and my father worked as an editor of The Charleston Gazette. While growing up in Charleston, we were by no means well off, but I enjoyed a richness that came from a loving and supportive family, a connection with my community, a love of learning and the belief that we could all live the American dream of service and success. I developed into an optimist who sees constant opportunity to create and contribute to a better world.
Not everyone is blessed with such support but, even for those who lack it, it’s possible to create purpose and connection. Doing so for those suffering from addiction can repair the fraying fabric of our community.
In 2019, let’s resolve to extend a hand to help West Virginians struggling with addiction to find purpose and reconnect. As Johann Hari writes, “the opposite of addiction is not sobriety. The opposite of addiction is connection.”
Clay Marsh, M.D., is vice president and executive dean for health sciences at West Virginia University.