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The effectiveness of a government is largely determined by its responsiveness: that is, its capacity to urgently address the needs and priorities of its citizens. The proliferation of opioid overdoses in recent years is largely a result of irresponsible and misguided federal policies. As the epidemic rages, the Federal Government has an obligation to intervene and correct its fatal errors.

Crucially, because the single issue of opioid related fatalities is peripheral and insignificant to the great majority of voters, it does not have much bearing in elections of representatives. Thus, the Federal Government must take responsibility and implement immediate policy changes through appropriate agencies. If it does not do so, the Opioid Epidemic will continue to call into question the responsiveness of the Federal Government to the American people.

Origins of the Crisis

The manufacture, distribution, and marketing of Oxycontin as a prescription drug in the United States in the late 20th century, is eerily similar to that of Heroin in Germany in the late 19th century. Both were synthesized in labs and marketed as drugs of utility; a stark contrast to how they have come to be abused.

Oxycontin, released in 1996 by Purdue Pharmaceutical, was marketed as a safe, non-addictive prescription painkiller. Such marketing was misleading. Oxycontin has proven to be a highly addictive, controlled substance. Those who develop addictions to the painkiller inevitably seek it after their prescription expires.

Strikingly, three out of four heroin addicts first become addicted to Oxycontin and other prescription pain pills. If Oxycontin cannot be procured, addicts are likely to begin to abuse heroin and fentanyl, the two substitutes which account for the majority of opioid fatalities. These two street drugs accounted for 47,000 deaths in 2017 alone.

The Federal Government is an integral motivator of this transition from ostensibly benign prescription of Oxycontin to fatal opioid abuse. This is, indeed, the very crux of the issue.

Culpability

The Federal Government has failed to understand or otherwise ignored the extremely addictive properties of Oxycontin and other prescription painkillers. This is explained in part by the intense, successful lobbying efforts of pharmaceutical companies to institutionalize a system of perverse incentives whereby doctors are compensated to prescribe specific drugs. Illustratively, in 2016, when the epidemic was in full swing, healthcare providers across the US wrote more than 214 million prescriptions for opioid pain medication—a rate of 66.5 prescriptions per 100 people.

Now, federal and state governments criminalise addicts, many of whom are victims of this political failure. Opioids are classified as schedule one drugs; possession and usage is a felony. West Virginia, the state with the highest rate of opioid abuse, also imprisons abusers at the highest rate. Imprisoning opioid abusers, the majority of whom are addicts due to the proliferation of prescription painkillers, is the lowest form of cruel irony. Such an arrangement of causes and effects demonstrates acutely the culpability of government in the deaths of nearly 50,000 Americans in 2018 and the hundreds of thousands which have occurred prior.

Essential and Immediate Policy Changes

The prevailing federal approach to resolving the Opioid Epidemic is a masterclass in ignoring successful public policy. Other countries, namely Canada, France and Switzerland, have faced similar, transferable opioid crises and have successfully implemented an array of initiatives collectively known as ‘harm reduction’. With the understanding that abusers will abuse, and that a great majority would prefer to quit but simply cannot, harm reduction provides safe environments wherein doses are gradually reduced and remedies to potential overdose, like Naloxone, are distributed.

The Trump Administration, in continuity with the Obama Administration, has allocated only $2 billion to the appropriate agencies for 2019. Yet the White House Council of Economic Advisers estimates that the total social cost of the opioid crisis to the United States in 2015 approached $500bn, or 2.8% of GDP. Such a disproportionate response is not only politically inexcusable but is foolish economics.

Now that the crisis is at a fever pitch and will only continue, the Federal Government should inject considerable, targeted funding into Medicaid, which provides healthcare to the indigent; and distribute direct, condition-less grants to state governments. This funding should be allocated to harm reduction programmes, which will not only reduce current fatalities but lower addiction rates in the immediate future.

In other words, opioid abuse must be treated as a public health issue rather than a criminal one. Criminalisation only exacerbates the growth of black markets for dangerous substances and lowers the propensity of addicts to seek help. The failure of the punitive 1973 War on Drugs illustrates this definite truth.

Crucially, the long recognised but never seriously regulated “kickback” system between pharmaceutical companies and doctors must be attenuated. Decisive legislation to sever this incentive structure will lower the incidence of initial addiction to prescription painkillers.

The Bottom Line

Harrowingly, in 2017 and 2018, life expectancy fell in the United States. The principal factor of this decline is the increasing incidence of opioid overdoses. Such a decline in life expectancy has not occurred in an industrial democracy since World War II.

Its culpability in the origins of the crisis, and lethargy in response, undermines the credibility of the Federal Government. The great majority of opioid abusers live in deprived areas where attitudes of resentment towards the “DC elite” have long festered. The lackadaisical, incoherent response to a palpable health crisis lends credence to this sentiment.

The Federal Government must now address its failure through appropriate policy, marshalling the immense resources of the modern American state. If it does not do so, the Opioid Epidemic may prove to be one of the most catastrophic failures of the American political system in the nation’s history.

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