- - Tuesday, January 3, 2017

ANALYSIS/OPINION:

According to the National Institute on Drug Abuse, drug overdoses claimed 55,404 American lives in 2015 — inflicting a greater death toll than automobile fatalities, gun-inflicted homicides and suicides. Eighty percent of these deaths were caused by the misuse of opioids, including legal pain medications, heroin and synthetic fentanyl. More than 2.5 million Americans take opioids such as oxycodone (Percocet, OxyContin), hydrocodone (Vicodin), and hydromorphone (Diludid). In 2012, 259 million U.S. opioid prescriptions were written. Representing 5 percent of the global population, Americans consume over 80 percent of all opioids.

Hospitals report a surge of opioid-addicted newborns. Misuse of legal opioids fuels demand for heroin and fentanyl. Opioid addiction can be used as an instrument to coerce victims of human trafficking. Rural Americans, southern states and veterans have been hit hard.

For the first time in American history, median U.S. life expectancy is declining — as a result of opioid addiction. From 2000 to 2015, more than 500,000 persons in the United States died from drug overdoses. These casualty figures not only reflect a national health emergency, but are emblematic of a war on the American people. By comparison, approximately the same number of Americans lost their lives fighting in World War II, Korea and Vietnam — combined.

Headed by Agriculture Secretary Tom Vilsak, the Obama anti-opioid initiative announced last January has failed to slow the onslaught. We have confronted drug crises in the past — implementing the following steps will ensure America turns the tide on the opioid epidemic in 2017:

First, any effort to mobilize interagency, intergovernmental action requires clear executive leadership. Recognizing the magnitude of the epidemic in New Hampshire last October, President-elect Donald Trump pledged a forceful, multifront assault on opioids. As Indiana governor, Vice President-elect Mike Pence has also shown resolve on this issue. Personal executive leadership and quantifiable benchmarks set by the White House will best ensure America’s victory over opioid addiction.



Second, House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell should schedule urgent legislative action to address the epidemic. Enacted into law in 2005, the Combat Methamphetamine Epidemic Act strengthened criminal penalties for the sale and distribution of methamphetamine. Of crucial importance, the legislation restricted access to legally available methamphetamine precursors ephedrine and pseudoephedrine, and targeted foreign manufacturers and traffickers. Congress must now expand criminal and civil penalties for the unlawful distribution, mislabeling, false marketing, diversion and fraudulent prescription of opioids, limit the accessibility of the legally prescribed precursors fueling addiction, and enhance interdiction, criminal penalties and enterprise liability for unlawful traffickers and distributors. Originally introduced by Alabama Sen. Jeff Sessions in 2005, Congress must also update, strengthen and reauthorize the National All Schedules Prescription Electronic Reporting Act to better identity, report and refer prescription drug abuse.

Third, coordinated enforcement and timely information sharing among federal, state and local enforcement agencies are essential. Targeted enforcement will shutter the “pill mills” and traffickers sustaining this surge against our people. With clear executive guidance, the Department of Justice, United States attorneys, Drug Enforcement Administration, Department of Homeland Security, Customs and Border Protection, Department of Health and Human Services, and state partners must synchronize enforcement against those who bombard our communities with legal and illegal narcotics.

Fourth, when it comes to freely prescribing opioids, health care providers and physicians must do a better job learning to “just say no.” According to the Kaiser Family Foundation, nearly all long-term opioid users indicate they were introduced to drugs by a doctor’s prescription, 60 percent indicate they received insufficient medical advice on their use, and 35 percent indicate that prescribing physicians failed to discuss the risks of addiction.

Last March, the Centers for Disease Control issued provider guidelines to reduce opioid prescription and dosage levels, but a substantial percentage of providers fail to comply. Federal regulators must ensure health providers, physicians and nurse practitioners adopt these guidelines, discuss risks of addiction, and fully explain non-addictive pain reduction alternatives to patients. Regulators must also establish criteria to ensure that those who suffer acute, severe or chronic surgical or cancer pain continue to receive appropriate medication. Finally, hospitals and providers must work more closely with law enforcement at all levels to identify and report potential instances of prescription fraud, diversion or abuse.

Fifth, addicts must be afforded greater access to treatment and recovery programs. While the 21st Century Cures and Comprehensive Addiction and Recovery Act are steps in the right direction, additional resources should be block-granted to states. Given the physical dominion that opioids exert over addicts, support for treatment and recovery is essential to reducing opioid demand and the attendant criminal activity that supplies and sustains it. The federal government and pharmaceutical industry must also support additional research into the pharmacology of addiction and recovery to end this epidemic.

Finally, prevailing against opioids requires greater public education and outreach. Americans must better understand the risks and costs of addiction, secure prescribed opioids from minor children and others, return or destroy unused prescriptions, and seek non-addictive pain medications in all but acute circumstances.

The opioid epidemic began during the presidency of Bill Clinton. It intensified and escalated during the administrations of George W. Bush and Barack Obama. With dedicated and coordinated action, we can and shall win the ongoing opioid war on the American people.

Robert N. Tracci serves as commonwealth’s attorney for Albemarle, Va. He previously served as deputy assistant attorney general and special assistant U.S. Attorney for the U.S. Department of Justice, and chief legislative counsel and parliamentarian to the U.S. House Committee on the Judiciary.

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