The opioid epidemic is, indeed, an epidemic. In 2017, the Center for Disease Control and Prevention (CDC) reported a record 47,600 deaths from opioid overdoses. The issue has become a much-talked-about issue among politicians, but they seldom approach it with any degree of nuance. Democratic Senator and presidential candidate Kirsten Gillibrand, for instance, has introduced a bill with Republican Senator Cory Gardner to limit opioid prescriptions to seven days with no opportunity for refills. This bill has received massive backlash, and justifiably. Laws limiting opioid prescriptions, which have been widely enacted in recent years, are exclusionary to chronic pain sufferers.
Michael Speers, a 21-year-old College of DuPage student and longtime friend of mine, suffers from Ehlers-Danlos Syndrome (EDS), which causes his joints to be hypermobile and prone to intense nerve pain. The severity of Speers’ condition means that opioid use is his most consistently effective treatment option. He said, “A thing that nerves do is that if they’ve sent pain signals to an area for a long time, they don’t stop. And there isn’t much of a scientific understanding of how to reverse that.” Dulling the pain, therefore, becomes the only viable treatment, and opioids are the only source of that relief.
While that may be unsettling, the fact is that few people that misuse opioids do so through a prescription. The National Institute on Drug Abuse reported that, among chronic pain patients prescribed opioids, only eight to 12 percent develop a disorder. All that the limiting of prescriptions does is provide further hurdles for chronic pain sufferers to jump through.
Based on an Illinois state law, for instance, Speers cannot receive any of his medication early, and is instead forced to visit his pharmacy the exact day that his prescription runs out. In the event of the pharmacy being out of stock, Speers could be forced to live without his medication for as long as it takes the pharmacy to restock. This would be a bad situation for any chronic pain sufferer, because as Speers said, “There are patients whose pain is so bad that they’re actively suicidal, and they’ll have no effective treatment beyond opioids. They’re fast, they’re effective, and they’re cheap.” For many, particularly impoverished sufferers that cannot seek more expensive treatment options, opioids are the only solution. Taking opioids away from these patients abruptly can result in withdrawal along with the intensifying of chronic pain symptoms. This is why the American Medical Association has warned against “blunt, one-size-fits-all approaches” like Gillibrand and Gardner’s bill—they make it harder for doctors and patients to enact healthy treatment options.
In addition, laws like these have been proven ineffective. Regulatory prescription laws have become popular in reaction to the opioid epidemic, but as “Seattle Times” op-ed writer Ramesh Ponnuru points out in his article “The war on opioid abuse is striking the wrong target,” “One might have hoped that […] reducing prescriptions would dent the death toll from opioids. But during this period, the overdose-death rate has kept climbing: Those 47,600 deaths in 2017 set a record.” Speers said of these laws, “They have no positive effect on anyone involved, but they look good on paper.”
Fortunately, Gillibrand has acknowledged this problem, saying soon after her and Gardner’s bill’s rollout that she wants it to “do what it was originally intended to do without harming patients” and that she is “open to improving the bill.” But regardless of these “improvements,” it is worth considering whether or not regulating the prescription of opioids is the solution at all.
For a proven solution, we should look to Switzerland. Peaking in 1990, Switzerland had a massive opioid epidemic in which up to two percent of its population were irresponsibly using opioids, mainly heroin. In response, the country decriminalized opioids and employed opioid substitution treatment, in which addicts were allowed subsidized doses of substitution products without the expectation of immediate abstinence. The program was a success, decreasing the popularity of street opioids and receiving a steady enrollment of around 18,000 patients a year. By decriminalizing opioids, addicts were given treatment rather than prosecution, and sufferers in need of opioids were allowed to use them responsibly.
In an article for the London School of Economics, drug policy analyst Christian Schneider supported the adoption of such a program in the US. Schneider acknowledged that Swiss taxpayers have had to pay for this program, and the same would be true if it were implemented in the U.S. But he added that “it is very likely that the societal costs of […] police forces trying to keep [opioid addicts and dealers] in check would be even more expensive.” In other words, substitution therapy would benefit the U.S. on both a humanitarian and economic level.
The opioid epidemic must be attended to, but “one-size-fits-all” solutions like Gillibrand and Gardner’s bill do nothing except disenfranchise chronic pain sufferers. In fighting this epidemic, we must keep in mind the effectiveness of addiction treatment and also ensure that sufferers like Speers are allowed a comfortable life.