Michael Botticelli, the director of National Drug Control Policy, announced in August that $13.4 million in funding would be devoted to High Intensity Drug Trafficking Areas (HIDTA). Of that, $5 million would be directed to a broad range of efforts that will reduce the trafficking, distribution, and use of heroin.
Impressive? Not to Dr. Andrew Kolodny, the chief medical officer of Phoenix House and the president of Physicians for Responsible Opioid Prescribing.
He charged the White House is completely missing the mark by all but ignoring the threat posed by people addicted, through no fault of their own, to prescription painkillers — opioids.
Opioids are painkillers such as morphine, methadone, Buprenorphine, hydrocodone, and oxycodone. Heroin is also an opioid and is illegal. Opioid drugs are sold under brand names including OxyContin®, Percocet®, Palladone® (which was taken off the market in 2005), Vicodin®, Percodan®, Tylox® and Demerol® among others.
Kolodny told PJM America is faced with a “severe opioid addiction epidemic; the worst drug addiction epidemic in the United States’ history.”
Kolodny said statistics from the Centers for Disease Control and Prevention show opioid addiction has reached levels much worse than the heroin epidemic of the 1970s or the crack cocaine epidemic of the 1980s.
The CDC has reported at least 220,000 Americans died from prescription opioid drug overdoses from 1999-2013. More than half of those deaths occurred from 2008-2013.
Kolodny said Obama’s handling of the problem has been “awful.” Like Reagan, Obama has been largely ignoring it.
“For six years, Ronald Reagan would not even say the word ‘AIDS’ in a speech,” said Kolodny. “The population for the disease was highly stigmatized groups. Some believe the AIDS epidemic would not have become as severe as it has if he had talked about it sooner and the federal government had paid attention to it earlier.”
“Obama has never once spoken publicly about the problem of opioid addiction,” Kolodny added.
Kolodny said there has been a 900 percent increase in people addicted to prescription opioids over the past 15 years. That is why overdose deaths are at historically high levels.
Some of those addicts and overdose deaths are the result of people getting the opioids illegally.
But Kolodny said many of them were using opioids exactly as prescribed by doctors. Ironically, the better a patient’s insurance plan is, the more likely it is he will become addicted to opioids.
The CDC said prescriptions for opioids began to soar in the late 1990s. The U.S. has 5 percent of the world’s population but consumes more than 80 percent of the world’s OxyContin and more than 99 percent of the world’s Hydrocodone.
“Opioid consumption in the United States is much greater than every Western European country combined,” said Kolodny, “and they do a better job in Europe of treating chronic pain than we are doing despite all of our opioid prescribing.”
Some have laid the blame on doctors and Medicaid fraud. Kolodny doesn’t.
He blamed the prescription industry, which told doctors for decades there was no need to worry about opioid addiction.
“They launched brilliant marketing campaigns in the late 1990s along with an enormous investment in educational programs with messages for doctors that said the risk of addiction was very low,” Kolodny said.
He also chastised leaders of the medical community who told doctors that if they were not prescribing opioids to treat pain, they were not practicing compassionate medicine.
“Doctors are prescribing too much, and getting people addicted,” said Kolodny. He said some pain management clinics actually use that as their business model.
“Patients never show up late for their appointments. They want their prescriptions. They want the drugs,” he said.
Kolodny is also on the steering committee of FedUp!, an organization lobbying the federal government to invest more money in education and addiction treatment programs.
FedUp! leaders, including Kolodny, stress this is not a partisan issue but it is “a ridiculously expensive problem the states are trying to deal with without any leadership from the federal government.”
Hillary Clinton has promised to invest billions of federal dollars into the effort to fight prescription painkiller drug abuse and better educate physicians about the possibility of addicting their patients to opioid-based medications.
It’s an issue Clinton said she was not aware of until she heard people talking about it during campaign stops in Iowa and New Hampshire.
“In state after state, this issue came up again and again – from so many people, from all walks of life, in small towns and big cities,” she wrote in an op-ed published by the New Hampshire Union-Leader.
Clinton’s plan, released Sept. 2, includes $7.5 billion in federal-state partnerships to create treatment programs, and holds out the potential of matching $4 in federal money to every $1 invested by a state government.
Sen. Angus King (I-Maine) heard about the crisis of opioid addiction during an August roundtable discussion with physicians, patients and government officials in Brewer, Maine.
“Opioid abuse has devastated too many lives, torn apart too many families, and imperiled too many communities in our state,” King said in a statement released at the conclusion of the roundtable event.
He also said that according to a 2014 CDC study Maine has the nation’s highest rate of prescriptions for long-acting, extended-release opioid pain relievers and is ranked 11th in its prescription rate for its high-dose opioid pain relievers.
The Maine Attorney General’s Office has reported the overall number of drug overdose deaths in 2015, which currently stands at 105, is on track to be similar to 2014, when 208 people died of overdoses – the worst year on record.
“Today’s discussion was a troubling assessment of that fact, but it was also a meaningful step forward to better understand how the federal government can expand its efforts to curb this terrible epidemic,” King added. “It’s clear that more must be done to help those gripped by addiction and that it will take a robust, concerted, and coordinated effort.”
However, all the money in the world won’t be able to solve the federal bureaucratic miscommunication on the opioid drugs that Kolodny said is chaining hundreds of thousands of Americans to their medicine cabinets — and providing their children with a steady stream of drugs to steal.
Kolodny said the CDC has been trying to get the word out to doctors to be cautious and stop over-prescribing opioids. But the Food and Drug Administration keeps approving new opioids and has even now approved the prescription of OxyContin for children.
Kolodny said before the FDA’s edict any doctor could prescribe OxyContin to a child suffering end-of-life cancer pain.
“But with this, they have now given the manufacturer of the drug permission to market the prescription of OxyContin to children 11 years of age and older, in the midst of an epidemic of opioid addiction caused by over-prescribing the medication.”
There is also another problem that all the money in the U.S. may not be able to solve: chronic pain and the number of middle-aged baby boomers who are hurting more every day.
The demand side of the equation for pain relief is not going away anytime soon.
“We have an aging population,” Robert Bonakdar, MD, director of pain management at the Scripps Center for Integrative Medicine in La Jolla, Calif., said in an article published by WebMD. “As the baby boomers get older, we’re going to have more and more people with chronic back pain, (and) osteoarthritis.”
Here’s the kicker: While the parents of baby boomers were from the school of “grit your teeth and bear it” when it came to physical ailments like back pain, their children are not.
“I think that baby boomers are less likely to accept the status quo,” Steven P. Cohen, MD, an anesthesiologist in the division of pain medicine at Johns Hopkins School of Medicine told WebMD.
“They have a sense of entitlement. Living the rest of their lives in chronic pain is just unacceptable.”