When President Donald Trump declared opioid abuse a public health emergency last October, it was unclear if this announcement would become a defining moment in ending our nation’s worst-ever drug epidemic. As the Charleston Gazette-Mail‘s Pulitzer-Prize winning reporting revealed, West Virginia counties were proven to be a dumping ground for opioid “pain-killer” drugs.
One year later, the outlook from Washington, D.C., is as murky here as elsewhere. The first U.S. president to campaign on ending the opioid epidemic now has the duty and political obligation of demonstrating progress. The ultimate measure of that progress will come when the Centers for Disease Control and Prevention reports annual drug overdose deaths in 2019 and 2020.
The public health emergency declaration falls short of the bold, purposeful action the nation needs, because it excuses the administration from making tough decisions on federal investments. A close look at the language reveals more authority is given to the Office of Management and Budget to control spending than the Department of Health and Human Services to actually mobilize for an emergency. The declaration, which is subject to renewal this month under the direction of the health secretary, should be superseded with stronger policy.
As Sam Quinones, whose book, “Dreamland,” traces the origins of the opioid epidemic, noted in Senate testimony in January, the space program provides a template for applying energy and focus to a complex challenge. The Apollo mission was a defining moment in our nation’s history where government succeeded in reaching its goal. The catalyst to getting the rocket off the launchpad was presidential leadership. “We choose to go to the moon,” President John F. Kennedy said. It is time for another moonshot.
The epidemic is enormously complicated, demanding attention from institutions ranging from local fire departments administering overdose reversal drugs to the FBI working to shut down illicit purchases on the dark web. The involvement of so many organizations across the country explains why an overwhelmed Congress in recent years has defaulted to passing legislation largely based on traditional funding formulas and state grants where it will be hard to quantify progress and sustain political support. Establishing priorities is a task not well-suited to Congress.
Perhaps as an anesthesiologist, whose profession was created to manage pain, I can offer some perspective on a possible moonshot. The over-treatment of pain is what unleashed this menace in the first place. The CDC describes the 1990s as the first wave of the current epidemic, when drugs such as OxyContin flooded the market. Note the CDC’s use of the term “current epidemic.” The invention of the hypodermic needle in the Civil War era to enable intravenous morphine delivery and the later marketing of so-called patent medicines, some of which contained heroin, led to addiction over 100 years ago.
The National Institutes of Health can lead the way in developing non-opioid pain medications, similar to how it pioneered the human genome project 20 years ago. Private sector pharmaceutical companies are working on developing alternative medications, but investors expect to see a quicker return-on-investment than research and development typically allow.
Trump backs, in concept, the discovery of alternative pain medications and cites the NIH as a key agency. Left unmentioned is funding. The president says only that the agency receives “billions” of dollars, suggesting the institute can make due with existing resources. The average investment to bring a new drug to market is $3 billion. According to NIH 2018 budget figures, $512 million is spent on pain research, a figure comparable to what is spent studying human sleep patterns and obesity.
Congress has appropriated $8.5 billion in funding to the opioid crisis this year in law enforcement, treatment and prevention programs. Legislation passed this month, which the president is expected to sign, continues this multi-pronged approach. But there is a vague feeling that we are fishing for perceived solutions that won’t end the problem. For example, Trump has suggested suing pharmaceutical companies and imposing the death penalty on certain drug kingpins. Such tactics will take years to produce results, if at all.
If we take a shot at curtailing the supply of opioids and succeed in making them irrelevant by developing nonaddictive alternatives, we will stop much of the demand. This mission alone will not directly address illegal heroin and synthetics, but it will sever the connection between treating pain and causing addiction. We need presidential leadership and commitment to make that happen.
Amar Setty is a practicing physician-anesthesiologist who serves on the board of Maryland’s prescription drug monitoring program.