My three favorite disaster movies of the 1990’s were Jurassic Park, Independence Day and Armageddon. In two of them, Jeff Goldblum plays a scientist who furiously warns those in power about the impending doom that awaits all of them if they continue to ignore the reality of the situation.
The modern opiate epidemic has been with us since 2005 and has been in full force since 2010. It continues to get worse every year (I am simply defining worse here as more deaths and am not looking at other rampant problems such as declining academic performance, workplace productivity issues, a glutted criminal justice system, or over-crowded, poorly performing treatment programs).
The opiate epidemic has been covered in the media, has led to the deaths of several high profile celebrities, has caused law enforcement to change their strategies and policies, and it has become the current fad for politicians on the local, state and federal levels to talk about. More people died from opiate overdoses in 2013 than in 2012. More died in 2014 than in 2013. When the numbers come in, I expect this to hold true for 2015.
I get it. People are concerned and those in power are trying. We have made important strides in the areas of prevention, treatment, recovery support and policy development. I am extremely appreciative of all the media attention that has been given to the opiate epidemic. And the money that has been set aside is far better than it was in the past.
It’s not enough. It’s not enough.
Today, the White House announced a $1.1B spending increase to “address the prescription opioid abuse and heroin use epidemic.” There are numerous programs and policies that are going to be established, funded or improved upon, and many of them are really good ideas. If you break down the money, it works out to be $11M per state for two years. It’s not enough.
There are three key points that the Federal Government could address but have not so far:
1) Before we increase the number of buprenorphine scripts that MDs can write, we must mandate the urine screens and counseling along with it. I’ve written about this, most recently for Hazelden (in an article that has already become the one most ever read on their site).
2) Sober homes and recovery housing (and whatever else people want to call it) must be regulated. There should be no exemptions (Oxford Houses have avoided regulation). Regulations include adequate and clean living space, reasonable access to transportation, reasonable access to treatment, reasonable access to 12-step meetings, minimum staffing guidelines, supervision and regular urine screens. A majority of sober homes and recovery houses do not meet these basic standards, and several cases, they are causing harm. They fight regulation claiming that these standards are too arduous and that they won’t stay open. Tell that to the parents of Chris Pesce, who died in a substandard sober house.
3) 49 of the 50 states have a prescription drug monitoring program (PMP or PDMP). Missouri does not. Only a handful of those programs are mandated, which means that the prescribers that are the worst actors with overprescribing are not checking the PMP nor entering information into it. I have told policymakers and politicians for years about the importance of having mandated PMPs in all 50 states and have them interconnected, so that as a clinician in NJ, I can check to see if my clients have gone to doctors or pharmacies in NY, CT, PA, DE, or MD.
We’ll finish with the immortal words of Richard Dreyfuss (Dr. Hooper) to the town mayor in Jaws (1:18 for those you that want to skip to it):
I think that I am familiar with the fact that you are going to ignore this particular problem until it swims up and bites you in the ass.
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