"If you know neither the enemy nor yourself, you will succumb in every battle."
Chinese general and military strategist Sun Tzu might have said just this about the state of Minnesota's "multiagency effort to address ... opioid-related deaths." ("Eager to quit opioids, facing red tape," Aug. 6.)
It's long been evident that neither the state nor the federal Centers for Disease Control and Prevention (CDC) knows the enemy in the government's war on the "opioid crisis." It's actually an illicit-fentanyl crisis. Both are fighting a target that doesn't rightly belong in the enemy camp: prescription opioids.
In the last five years, opioid prescriptions have dropped by 25 percent while opioid overdose deaths have increased 25-fold, as confirmed by the CDC's July 11 report announcing a "sharp rise in overdose deaths involving [illicit] fentanyl … [and a] continued increase in … supply of [illicit] fentanyl … ."
The Star Tribune's Aug. 6 article describing barriers to drug treatment with buprenorphine "for opioid abuse" and "opioid addiction" does not refer to the CDC report — which gets worse: "Deaths involving illicit fentanyl … more than doubled from 2015 to 2016 … from 14,440 to 34,119." There were 25,460 such deaths during the first six months of 2017 alone.
The story does not discuss what kind of opioids those seeking treatment are addicted to. The state "efforts" mentioned are the crusade against "opioid prescribing" and increased access to treatment. It's safe to assume that most readers, after reading that, will conclude that opioid prescriptions are to blame.
Why does it matter what opioids we're talking about? Because feeding the public on the word "opioid" plus "addiction, deaths, abuse and overdoses" with a side of the word "prescription" is disingenuous. It's tantamount to suggesting that there are 1,000 annual deaths due to eating fish, both rotten and untainted. Unless you state that one person died eating untainted fish and 999 died eating rotten fish, the reader will believe that fish, generally, are the problem.
"Illicit opioids … not prescription opioids … [are] driving … overdose deaths," writes Dr. Michael Schatman, director of research and development at Boston Pain Care and editor-in-chief of the Journal of Pain Research. "This critical distinction is often ignored or underappreciated by the press and policymakers, and … needs to be emphasized by the CDC. The failure to do so has far-reaching consequences … ." Some of these are on display in the Star Tribune article.
Getting buprenorphine in Minnesota is difficult for everyone who needs it. If policymakers were serious about solving the "opioid crisis," they'd focus less on eliminating prescription opioids and more on facilitating access to this important medicine.
Instead, obtaining it is an onerous process involving the insulting experience — signing a contract promising not to steal and lie — of becoming a patient at a pain clinic, where drug addicts and pain patients, uneasily lumped together, wait for the specially licensed doctor to dole out a prescription hard copy they've perhaps driven for hours to get.
Dr. Mark Willenbring of the University of Minnesota's Department of Psychiatry and founder of Alltyr Clinic pointed out in a 2014 Star Tribune commentary ("Filling an addiction treatment gap"): "Buprenorphine … may only be available from cash-only clinics that charge $300 … for five minutes with a doctor and a prescription … [and] this lucrative-but-exploitative practice has attracted far too many unqualified physicians … ."
Many doctors hesitate to prescribe buprenorphine because of the implications for their practice. The first dose can't be given unless the patient is in withdrawal, and the prospect of a waiting room full of such patients is less than attractive.
The failure of policymakers to identify the complexity of the issues in this crisis is the main reason no effective solutions exist to solve it. Consider U.S. Attorney General Jeff Sessions' idea, sure to deter Chinese and Mexican fentanyl cooks from peddling their wares to U.S. drug addicts. If the Drug Enforcement Administration "believes that a company's opioids are being diverted for misuse," he said in prepared remarks about proposed regulations earlier this year, "then they will reduce the amount of opioids that company can make."
So if fewer prescription pain pills are made, fewer drug addicts will die of prescription opioid pills they're not abusing to begin with and that aren't killing them?
That looks like a solution one might expect in response to the aforementioned hypothetical fish-related fatalities: Kill all fish (that can be shot in a barrel).
Iris Erlingsdottir is an Icelandic journalist and writer. She lives in Northfield.
