America's opioid crisis: Trump's pragmatic approach
U.S. President Donald Trump has unveiled his plan to combat America’s opioid crisis.(i)
Trump presents an interesting mix of support for social programs, reduced funding for certain medical drugs and harsh, authoritarian measures. Predictably, this rather nuanced approach has sparked a mixed reaction.
It’s important to first clarify that The United States is suffering from a certifiable crisis in regards to opioid addiction.
In 2014, 4.3 million Americans were non-medical users of prescription painkillers and 435,000 had used heroin in the past month.(ii)
Of the 20.5 million Americans 12 or older who had a substance disorder in 2015, 2 million of these involved prescription pain relievers and 591,000 involved heroin.(iii)
The majority of substance use disorders in America (17 million) are due to alcohol, though considering over half (176.6 million) of people in the United States use alcohol, this figure is less severe.(iv)
A consequence of this high rate of opioid use is a very high rate of opioid overdoses.
Since 2010, America has seen a rapid rise in both heroin and synthetic opioid overdose deaths:
https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
In 2016, opioids were involved in 42,249 deaths, up 500% since 1999, and a statistically significant increase since 2015.
For contrast, this figure has surpassed the number of car fatalities at 37,461 in 2016(v), and gun deaths at 38,000.(vi)
The largest and fastest rising culprit for opioid deaths is a synthetic opioid known as Fentanyl.
Fentanyl is a powerful painkiller 50-100 times more potent than morphine, meaning overdose is a predictable occurrence if not taken under controlled circumstances.
Evidence suggests that a portion of these deaths are due to existing opioid users being unaware of the drug they are taking - a reality of heroin being illegal and other prescription medication being obtained illegally.
In California in early 2016, 36 overdoses including 9 deaths occurred as a result of Fentanyl, though users thought they were taking Norco or Hydrocodone, a more mild painkiller.(vii)
In March that same year, a Euclid man was arrested with possession of what appeared to be 925 Oxycodone pills, found to be Fentanyl when tested.(viii)
What is the source?
It’s well established that the majority of narcotics enter the U.S. through Latin America, particularly Mexico.
According to the DEA in 2015, Mexican Transnational Criminal Organisations pose the greatest criminal drug threat to the United States, and in December 2017 a man was charged with smuggling 77 pounds of Fentanyl into the United States from Mexico. (ix)
However, it appears the drug can originally be sourced to Chinese suppliers.
In Spring 2015, Chinese customs seized 70 kilograms of Fentanyl bound for Mexico.(x)
In April 2016, a dozen packages were shipped from China to residences in Southern California containing a pill press and materials for manufacturing Fentanyl.(xi)
This evidence suggests Mexican suppliers are sourcing their Fentanyl from China before smuggling it to the U.S., though the drug is also being shipped directly to the U.S. from China.
Australia by comparison
In Australia, overdose statistics are similarly grim.
In 2015, accidental drug deaths (1,489) more than doubled the number of car fatalities (712). (xii)
Similar to the U.S., synthetic opioids top the charts for overdose deaths, with Oxycodone, morphine and codeine leading the death rate.
Fentanyl is comparatively less of a problem here than in the United States, though the death rate is rapidly rising - from 2010-2015 498 Fentanyl related deaths occurred, marking an 1800% increase on the previous decade.(xiii)
Trumps plan
Though the finer details are not yet available, there are a number of confirmed proposals laid out by the Trump administration. The plan as a whole is pragmatic, with a variety of different methods being implemented. (xiv)
Perhaps on the less controversial side, the government will change how they pay for opioid prescriptions in order to limit access to painkillers.
With this plan implemented, the administration claims it will reduce opioid prescriptions by one-third within three years.
One aspect of the plan could be considered aligned with progressive thinking, perceived as an effort to treat drug addicts as in need of medical treatment rather than punishment: It includes scanning federal inmates for opiate addiction and steering these addicts towards treatment centres after release.
One initiative, recommended by The Presidents opioid commission, is increasing first responders access to naloxone, a medication used to reverse opioid overdoses.
An aspect that sounds highly practical is the suggestion of setting up a data base monitoring prescription drug sales, meaning health care providers can easily flag patients seeking out numerous opioid prescriptions.
Australian pharmacies use a similar database to monitor the sales of pseudoephedrine - an over the counter medication which can be used for the illicit production of methamphetamine.
As criticised by a number of news sources, the plan also includes authoritarian measures, such as creating a new task force with the goal of strictly monitoring internet sales.
The most widely publicized suggestion by Trump is the implementation of the death penalty for drug dealers.
Trump has allegedly spoken to the president of Singapore about the drug issue. According to a source close to Trump: "He says, 'When I ask the prime minister of Singapore do they have a drug problem [the prime minister replies,] 'No. Death penalty'."(xv)
Reiterating this position, he claimed on Monday that dealers “will kill thousands of people during their lifetime” but suffer little punishment, though specified that the death penalty would be used against the “big pushers, the ones who are really killing people”(xvi)
Trumps claim that countries like Singapore have much less of a drug problem as a result of the death penalty is hard to verify.
A writer from The Conversation explains in detail why this is the case.(xvii)
First of all, drug injection rates for Singapore are unavailable, as detailed by Harm Reduction International’s study into the rate of HIV throughout Asia.(xviii)
Drug overdose rates for Singapore are also undocumented by the Singapore government.
The only data available is the ‘demographic profile of drug abusers’ I.e. people who come into contact with the health or criminal justice system for drug treatment.(xix)
This method differs from a country like Australia, which collects data from various different research organisations, including from anonymous phone surveys, school students, existing drug users and law enforcement.(xx)
Taking this into account, it’s likely Singapore’s drug use statistics are enormously understated, and the effectiveness of their death penalty policy unknown.
It’s evident America is suffering from an opioid crisis, and it’s refreshing to see President Trump is taking a pragmatic approach in order to try and solve it.
Increased access to naloxone, more sympathetic assistance for addicts and the monitoring of prescriptions are all a step in the right direction.
However, it’s unfortunate Trump is of the opinion heavy handed authoritarian policies will be effective, considering the ineffectiveness of said authoritarianism for the duration of the drug war.
Sources:
i:https://www.politico.com/story/2018/03/15/exclusive-trump-finalizing-opioid-plan-death-penalty-418488
ii:https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
iii:https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
iv:https://www.samhsa.gov/disorders/substance-use
v: https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in_U.S._by_year
vi:https://en.wikipedia.org/wiki/Gun_violence_in_the_United_States
vii:http://www.dhhs.saccounty.net/Pages/NR-Update-on-Opioid-Related-Overdoses-QandA.aspx
viii:https://www.justice.gov/usao-ndoh/pr/euclid-man-indicted-distribution-fentanyl-and-crack-cocaine-also-faces-firearm-charge
ix:https://www.dea.gov/docs/DIR-040-17_2017-NDTA.pdf
x:https://www.justice.gov/usao-sdca/pr/defendant-charged-smuggling-77-pounds-deadly-fentanyl-united-states-one-largest
xi:https://www.statnews.com/2016/04/05/fentanyl-traced-to-china/
xii:http://www.penington.org.au/australias-annual-overdose-report-2017/
xiii:http://www.abc.net.au/news/2017-11-24/deaths-from-prescription-drug-fentanyl-up-by-1800pc/9184396
xiv:https://www.politico.com/story/2018/03/15/exclusive-trump-finalizing-opioid-plan-death-penalty-418488
xv:https://www.axios.com/exclusive-trump-privately-talks-up-executing-all-big-drug-dealers-1519595170-402cc386-8729-4684-a7ef-a5bf31876afa.html
xvi: https://edition.cnn.com/2018/03/19/politics/opioid-policy-trump-new-hampshire/index.html
xvii:http://theconversation.com/trump-take-note-why-singapores-claim-that-the-death-penalty-works-for-drug-offences-is-fake-news-92305
xviii:https://www.hri.global/files/2016/11/15/Asia.pdf
xix:https://data.gov.sg/dataset/demographic-profile-of-drug-abusers?resource_id=07553b43-2277-4497-9873-a00a92f37f3e
xx:http://www.ausstats.abs.gov.au/ausstats/free.nsf/0/98D51DF7A8241A70CA256B1200010389/$File/48080_2001.pdf
