As a physician, I believe that the opioid epidemic in America is a tragic, complex and multifaceted issue that has been caused by failures at many levels. We must acknowledge that our strategies have failed and we need a strategic legislative reset to effectively address and finally resolve this deadly problem.
I would like to commend the Biden Administration for the recent passage of the Mainstreaming Addiction Treatment (MAT) Act, which has the potential to make a significant impact. However, I can assure you that, as of today, not even one percent of doctors know about MAT and its implications. This act will not go into effect until June 21, 2023, and until then there will be no improvement in access to care or a reduction in overdose deaths. Fentanyl has almost completely replaced prescription drugs as the cause of overdose deaths. Yet all the laws to curb pills and pill mills are still in place.
The opioid crisis has been driven by a disconnect between what policymakers hope for, what drug manufacturers want and what politicians do not want. There are three areas that need the most focus and attention: drug classifications and misplaced priorities; the lack of trained professionals in the field of addiction medicine; and misguided legislation.
Overall, the main reason for this strategic failure is the lack of application of common sense.
The classification and prioritization of drugs needs attention. The escalation of deaths caused by fentanyl, heroin, methamphetamine and cocaine has been due to several factors. These include the lack of training for doctors in pain or addiction medication and the shuttering of more than 1,000 doctors in the past 20 years. Common sense needs to be applied and the Accreditation Council for Graduate Medical Education (ACGME) needs to start providing education on addiction in American medical schools to train new doctors to tackle the opioid crisis more effectively.
The opioid crisis started in America because of Oxycontin and Morphine. Yet there was no Diversion Control Plan (DCP) on either of these drugs. The Drug Enforcement Association (DEA) has never had a diversion control plan. Knowing this, why has there been a DCP on Suboxone/Buprenorphine since 2005, when these drugs are recognized as the most workable remedy for combating the opioid crisis?
Based on my experience with Substance Use Disorder (SUD) patients, those who have been prescribed Suboxone/Buprenorphine are doing much better than those who do not have access to this medication and are revolving door patients at addiction clinics. Policy makers must focus on the lack of access to care which is the leading cause of the rise in overdose deaths. The criminalization of the treatment arm has been the worst barrier to access to care. Buprenorphine does not feature on the list of top 20 drugs that cause deaths among people suffering from SUD/Opioid Use Disorder (OUD).
The DEA reported that the United States manufactured and consumed most of the world’s prescription narcotics in 2000. However, there has been a 53% reduction in narcotic manufacturing in the U.S. since 2016; 99% of American doctors have no training in pain or addiction medication.
More than 1,000 doctors have shut down their practices in the past 20 years, causing panic across the medical field. Others pay attention and are scared or not willing to risk their licenses and livelihoods trying to take care of these very complicated patients with no education, knowledge or experience in the area. The government needs to be an ally in this, not an adversary.
The lack of trained professionals in the field of addiction medicine, along with unnecessary restrictions and oversight, prevent doctors from prescribing remedies. If the ACGME had started training and providing education on addiction in medical schools from 2000 when the Drug Addiction Treatment Act was passed, we would have produced 20,000 new doctors every year since then who would have been ready to tackle the opioid crisis. In 22 years, we would have had 500,000 new doctors, prevented this disaster from becoming an epidemic and saved millions of young Americans from dying. Unfortunately, ACGME has still not taken any steps to change the medical school curriculum. In no other field of medicine are there so many restrictions, limits or oversight. Why in addiction medicine?
This lack of access to care is one of the leading causes of the rise in overdose deaths. In addition to the shortage of trained professionals in the field, addiction doctors face unnecessary limits, regulations and oversight that prevent them from being able to prescribe remedies.
Misguided legislation is another area of severe frustration. Laws against Class I or Schedule I drugs are very soft. Schedule 1 drugs are classified as having a high abuse risk. These drugs have no safe, accepted medical use in the United States. It is noteworthy that THC/Marijuana is a Schedule I drug but is legal or decriminalized in 35 States. Class II or Schedule II drugs, on the other hand, are drugs with a high abuse risk but which also have safe and accepted medical uses. Fentanyl is similar to Methadone, Oxycontin and morphine but is a useful drug in a hospital setting for short surgical procedures and yet it is designated as a Schedule II drug. Unfortunately, street fentanyl has been killing more than 300 young, healthy Americans per day for the past three years. The DEA reported in 2020 that the U.S. manufactured and consumed the majority of the world’s prescription narcotics, contributing to the escalation of deaths caused by fentanyl, heroin, methamphetamine and cocaine. We need to differentiate between legal and illegal fentanyl and strengthen the laws against illegal drugs. We must declare illegal drugs as weapons of mass destruction and, at best, ban fentanyl in America.
Alternatively, Buprenorphine should be provided free to all those in need. Providing free Buprenorphine dispensing and vending machines across the country would eradicate the need for expensive Narcan, which does not work well in overdose situations. People will not die and it is a very effective and cheaper option for saving lives.
The MAT Act is a step in the right direction but more action is needed. America must be saved from within. Let doctors be doctors and foster immediate ways for them to work with legislators to enact a strategic reset in America’s war against the opioid epidemic. By working together, we can save millions of young people from dying over the next two decades. This will be the most important step towards humanity and a remarkable peace project.