The Economic Consequences of Opioid Addiction in America

We can stop the pipeline from prescriptions to heroin by changing how doctors handle
opioid-dependent patients. Currently, when doctors suspect a patient has become
dependent, they treat the patient as a criminal. They immediately cut off the
prescription, ask accusatory questions, require drug tests and threaten criminal
proceedings. Instead of providing help, doctors force the patient to quit a notoriously
addictive drug in silence. Many patients begin to buy pills on the street, where dealers
introduce them to heroin. To stop the pipeline, doctors must continue to approach
patients as patients, not suddenly treat them as criminals. Addiction experts recognize
that dependent users need to transition off of opioids gradually, instead of trying to quit
“cold turkey.” In many cases, the greatest obstacle to connecting a patient to treatment
is the patient’s own doctor, who considers addiction a simple matter of willpower. In
other cases, the doctor fears that supplying pills to a dependent patient will expose
them to criminal charges. The Drug Enforcement Administration (DEA) needs to ensure
that doctors can treat patients’ addictions responsibly without fearing prosecution.
For the millions of people who have become addicted to opioids, we need to expand a
number of underused interventions proven to avoid overdose, stop dependency, and
prevent the most damaging consequences of opioid abuse. These include: (1) Naloxone
Access and Good Samaritan Laws, (2) Medication-Assisted Treatment, and (3) Safe-
Injection Facilities.
Naloxone Access and Good Samaritan Laws
We need to make sure that patients survive their opioid addictions. Many are surprised
to learn that heroin overdose deaths are entirely preventable. Naloxone (brand name
Narcan), which is administered by injection or nasal spray, reverses overdose within
seconds by dislodging the drug from the brain's opioid receptor sites. Naloxone is
available in hospitals and carried by paramedics and some police officers. In a small
number of cities, community-based overdose programs train users, family and friends to
administer naloxone.
If we can stop heroin overdoses, why do they still claim the lives of twenty Americans a
day? Users of illicitly purchased opioids tend to use alone and in hiding, where they are
likely to die in case of an overdose. Any heroin user who attempted to ensure his or her
safety by injecting in a hospital or near a policeman would be arrested. Even when
users overdose around others, fellow users often hesitate to call 911. In 29 states, if a
user calls 911 to save a friend from overdose, police can arrest those at the scene for
drug possession. In these states, users often abandon those who overdose to avoid
arrest.
These obstacles can be removed through Naloxone Access and Good Samaritan
Laws. Since naloxone cannot be abused, it should be distributed to anyone likely to
witness an overdose, including users and their friends and families. All states need to
allow pharmacies to dispense naloxone over the counter to anyone who cares to carry
it, as California has done. Local governments and nonprofits should train those likely to
Page 66 of 159