My take on Trump’s plan for Opioid crisis

In March 2018, President Donald Trump unveiled his plan for dealing with the opioid crisis. Like his predecessor, he began his campaign with a study to examine the extent of the problem. President Trump is quoted as saying, “Failure is not an option. Addiction is not our future.”

Trump’s Plan for Opioid Crisis

In a speech given in New Hampshire, a state that has been hard-hit by opioid addiction, he outlined steps he believes necessary to bring the escalating problem to a halt:

• Death penalty for dealers
• Federal funding to encourage development of non-addictive painkillers
• Major litigation against drug companies that manufacture addictive drugs for inappropriate sales practices
• Frightening videos highlighting the dangers of addiction to be shared with youth
• Reduce the illicit drug supply – which Trump believes to primarily come from south of the border.
• Make medical treatment for addiction more affordable
• Supply first-responders with drugs needed in cases of overdose
• Get tough with sanctuary cities that could potentially be sheltering drug dealing criminals.

Trump explained that these measures would be in addition to those announced last year. He feels that by putting them in place he can cut the drug problem by one-third in the next three years. He went on to add that the plan would not only target illicit or illegal drugs, but also focus on doctors who over-prescribe pain medications and the large drug companies that encourage the use of these products.

Critics of Trump’s Plan

Critics of Trump’s plan feel that it has some inherent flaws. He has been accused of using the Opioid crisis to continue to push his immigration agenda, of having little that’s new to offer, and a lack of supporting budget for the measures outlined.

This might be a good time to take a step back and to remember that a president, however influential, is still only a man. There’s a well-known aphorism that it takes a village to raise a child. It might also be noted that it takes a nation to bring about real reform of this sort.

Looking at the Big Picture

According to the National Institute on Drug Abuse, every day about 115 Americans die of an opioid overdose. That number doesn’t encompass the number of people whose lives are changed for the worse after using opioid drugs – legally or illegally. An estimated cost of $78.5 billion per year is believed to derive from misuse of prescription drugs alone. Costs are derived from a calculation of work hours lost, property damages incurred and health problems deriving from the misuse of prescription opioids. Illegal substances drive the overall cost even higher. This does not count the extended costs that include impact on families and young children associated with the person using the opioids.

A Little History on Opioid Development

Opioids have long been used by physicians to alleviate severe or chronic pain. They have even been used in medicines such as extremely potent cough syrups. If you’ve ever had to sign the “poison book” when getting a strong cough syrup, you’ve used a medicine containing an opioid.

In the late 1990s, drug companies set about developing non-addictive painkillers. They assured physicians that these strong medicines could be prescribed without fear of their patients becoming addicted to them. Sadly, it soon became apparent that this was not the case. Many of the new medicines were just as addictive as the old ones, and availability had become widespread. There was a sharp uptick in the numbers of deaths from opioid overdose – both from prescription drugs and from street drugs.

Opioid Statistics from NIH

Some disturbing figures published by NIH are as follows:

• At least 21% of patients with opioid prescriptions for chronic pain abuse them
• Twelve percent of patients who receive prescriptions for opioids become addicted
• Between 4 and 6 percent of those patients transition to using heroin
• Eighty percent of heroin users began by using prescription drugs
• There was a thirty percent increase in opioid use between 2016 and 2017 in 45 states
• The Midwest region saw a seventy percent increase in use

Seeking Solutions for the Problem

The NIH is encouraging and supporting research into non-addictive medication for pain management, new and better treatments for addiction, and prevention and reversal techniques to assist recovering. It’s seeking to do this through partnerships with pharmaceutical companies and University research programs.

Addiction Vaccine

One such program is an “addiction vaccine” which has been tested in mice. It shows some promise as an added tool in the physician’s arsenal for helping people who are addicted. You might ask, with some reason, how this could possibly work since drugs are not a disease or a virus.

How Opioids Work

The answer lies in how opioids work. To reduce the perception of pain, opioids attach to opioid receptors in the body. In the process, they also pass over into the brain, where they interact with the pleasure and reward centers of the brain. Some patients come to enjoy the sensation. Long-term use can develop dependency or addiction. Excessive use can result in decreased respiration (the brain no longer tells the body to breath) and even death. Completely, suddenly removing the drugs can cause painful withdrawal symptoms including muscle and bone pain, vomiting, diarrhea, chills, sweating, involuntary movements and goosebumps. Drugs given to support addicts and wean them off their drug of choice help keep these symptoms in check, but they sometimes create a new dependency.

How the Addiction Vaccines Would Work

The drug vaccines would work with the drugs used to reduce discomfort for patients who are recovering from dependency or addiction. The vaccine that’s currently being tested is designed to help with addiction to oxycodone and hydrocodone – two of the drugs that emerged in the 1990s and were intended to be non-addictive. The way the vaccine works is that it binds to the drug in a way that causes the body to treat it as if it were a virus. It also makes the drug molecules too big to enter the brain cells. By combining these two effects, it prevents the pleasure responses that fuel the addiction process. Or to put it another way, it lets the body see the drug as an invader and allows it to treat it as a virus while taking all the fun out of it.

The addiction vaccine is part of President Trump’s plan. Unfortunately, it has a long way to go before it can be used in humans.

Social Solutions

One critic pointed out that while programs to help people off drugs and get them back into society as productive citizens were good, what’s really needed are programs that prevent the kind of despair and dysfunction that promotes escapist use of drugs in the first place – a carrot to go with the scary publicity stick as prevention. One such program is support for people who have been convicted of crimes, helping them to rehabilitate and move forward to better lives.

The President’s program has many good points, but drug abuse is an old problem that has been around for centuries. While his outlined program might help, and could provide assistance for some people, it could be only a small part of what is needed. Or to put it another way, it’s flawed but not invalid. 

Dr. Vikram Tarugu MD

Dr. Vikram Tarugu, M.D, is the CEO of Detox of South Florida, Inc and medical professional focused on addiction. A veteran in the medical field with over 25 years of professional experience. He is a consultant for many South Florida Rehab centers. Patients travel from allover the US to seek his help with addiction and Hepatitis C treatment.