By R Carter
In the United States, the opioid crisis has passed into the pages of our history and is now a mostly forgotten topic. It’s an issue I started talking about in 2019 as many in the chronic pain community had reached such levels of apathy or rage that engaging them in forms of peaceful demonstrations to raise awareness simply fell on deaf ears or was drowned out by the shouting of angry protests.
Why do I believe this? These four rules, their ties back to financial profit, influence over others or political power, are the basis of the choices most of us make, either consciously or unconsciously.
#1. It’s typical human behavior. If an issue doesn’t impact you personally, we all tend to ignore it as our lives are busy with issues that do impact us and have some kind of payoff.
#2. It’s old news, as always, the news cycle is driven by the most current events on a national level, which is an ongoing debate, or some would say gossip, of what he said versus what she said. A debate that plays out on the pages of every national media publication. Media publishers are driven by rule #1.
#3. The general perception is that the problem has been dealt with or mostly dealt with in the eyes of most Americans, particularly of those in political leadership positions.
#4. There’s little to no payoff, monetarily or politically of returning to a debate on opioids. This view is driven by rule #3.
To make my case for such a conclusion I’ll start with how I monitor the ongoing debate around the opioid crisis.
Most people know what an RSS reader is, RSS stands for Really Simple Syndication, it a software tool that allows media publishers to publish online, brief exerts from their daily or weekly publications. RSS readers when given a URL link, can scan these exerts, filter them, and display the exerts for viewing. The users simply click on a link to read the full publication or with some software tools, download the exert, or the full publication for inclusion into blogs and other types of websites.
I use such a tool to speed up and simplify my efforts at monitoring what government and media publish in regards to the opioid crisis. I follow key RSS feeds from government agencies such as the CDC, DHHS, NIH, NIDA, SAMHSA, VA, US Federal Courts, Department of Justice, public advocacy, political action and social media groups such as CATO Institute, American Council on Science and Health, a large variety of medical publications and clinical journals, state medical boards, major news outlets such as CNN, FOX, NBC, ABC, CBS, NPR, New York Times, Washington Post, international media outlets such as The Guardian, some state or local media outlets, and a number of Facebook pages all focused on the topic of the opioid problem here in the US. In all, I monitor more than 200 hundred RSS feeds, blogs, and websites.
At the peak of the opioid crisis, around January 2018, I was receiving on average, about 200 to 300 articles per day, a daunting review task were it not for the use of an RSS reader. On average about 20% of those directly dealt with the opioid overdose death problem, the remaining covered addiction, abuse, and treatment for all types of drugs. Of the 20% that exclusively addressed opioids, 99.5% implicated prescription opioids as the underlying cause for the opioid crisis, but when looking at how the data was collected and interpreted, there were major holes and oversights in those processes, and in some case, an outright license to abuse, hijack and distort the truth for political gain, i.e. the 2016 CDC Guidelines for Opioid Prescribing.
Less than 1% of the research done held a position that prescription opioids were a false narrative in regards to identifying the underlying cause for the continued rise in opioid-related deaths and in the 99% that did hold to this view, it was based on government data which had the problems I previously listed. More importantly, was a lack of research that showed how the policies implemented by government were impacting those with a legitimate medical need, as in this survey done by CERGM in 2019 of 860 chronic pain patients across the nation.
Having followed the opioid problem for more than ten years and focused full-time on the topic since mid-2017, my concerns over how it was portrayed in the media is what drove me to dig deeper into the science and research being conducted by the government. As I read and walked back each referenced article in each publication, whether from the media or from science and research, as much as 95% of the time, my efforts landed me on work which was funded by a federal or state government, or through donations and support from groups with mostly right-leaning and occasionally, left-leaning political agendas. For that reason, to say the opioid crisis was purely a health issue for Americans, rang hollow in my ears. One need look no further than the CDC to see how such agencies relinquish their core mission under the weight of a political agenda. When such bad science is published for general consumption, particularly on a topic that has strong biases leveraged against it, the outcomes always lead to greater abuses and deaths, with medical care declining rather than improving, proving that two wrongs don’t make a right.
Based on the four rules I mentioned at the start of this post, in 2019 I began advising those in the chronic pain community to be patient, that eventually, the laser focus on prescription opioids would soon give way to other issues facing the nation. As early as the spring of 2019 there were signs of this occurring, major media outlets had already started moving on to other topics in the news, all that was needed to permanently close the door on this subject was another major controversy in the national media.
That began in earnest in September 2019 when the House began impeachment inquires against sitting president Donald Trump. A formal impeachment vote in the House of Representatives took place on December 18, 2019, followed by a U.S. Senate trial which began on January 16, 2020. On February 5, the Senate acquitted Trump on both impeachment articles.
Next, the media and the nation shifted its attention and focus to the democratic debates and the state primaries that were coming in March-May 2020, along with the debate over nation-state interference in the election process, primarily Russia. But all of this was hijacked by the world-wide pandemic of COVID-19, one that rivaled the 1918 Spanish flu pandemic which killed 50 million people. With a national lockdown in progress, the nation’s economy nearly ground to a halt, and federal and state legislators along with every federal and state agency were forced to address the issue. By May 2020 with more than 36 million unemployment claims, the nation was forced to put all its efforts into combatting the virus and prevent the nation from falling into an economic collapse.
The nation had forgotten about the opioid crisis, those 200 – 300 per day articles I was once received via RSS feeds, had now fallen to less than 10 per week by May 2020. This was clear and unmistakable proof that the government and the media had moved on to other issues facing the nation.
What came next was predictable. With hundreds of millions of Americans stuck at home, employed or not, the anger and resentment over existing inequalities came to a boiling point. All that was needed was one of those inequalities to catch the attention of America and provide a catalyst, spilling over into demonstrations and anarchy on the streets of America.
That event was the senseless death of black American George Floyd at the hands of a white police officer. The marches and demonstrations were mostly peaceful, but anarchists seize on such opportunities to hide within the ranks of peaceful protesters and under the cover of darkness, turn to riots, looting, and burning. As someone who grew up in the sixties, still having images in my head of peaceful protesters, so call flower children, placing flowers into the gun barrels of national guard troops then seeing those troops turn on protesters killing 13, i.e. the Kent State Massacre, what follows next is also predictable.
The nation will be engulfed for the next year, likely longer, in the debate and counter debate over the handling of COVID-19, the economic fallout from it, civil rights violations of peaceful free speech and assembly, all tied to the government’s response, particularly the Trump administration’s handling of it.
What comes after that is anyone’s guess, but it’s sure not to be the opioid overdose problem, this is widely viewed by both political parties as an issue that has been dealt with. Even if Biden wins the election, his views on the opioid overdose problem as being a prescription drug problem seems to be in locked step with that of the Obama administration. With what his administration will be inheriting from Trump’s four years in office, his first four years in office are sure to be dominated by recovering from the economic fallout of COVID-19, putting American’s back to work while keeping them safe from a virus which still has no cure.
Barring a major political shift, i.e. more liberal elements coming into political power in the house and senate, the existing laws and regulations in place over opioid prescribing for chronic pain conditions will remain as it is for the foreseeable future.
This should not be seen as discouraging news, it is instead an opportunity to address some of the inequalities falling onto the chronic pain community, particularly for those with a legitimate medical condition that can only be effectively treated with opioids. With the laser focus that was placed on the subject by previous administrations, and with an election little more than four months away, now is the time to effect political change which can be a first step at reversing the direction of the extreme right who demonized the medical use of opioids simply because they were drugs used by street addicts. The chronic pain community can now shift its attention to redefining a more rational approach to treating chronic pain by disconnecting the medical treatment issues from the imagery of legalized drug abuse, a perspective widely adopted and encouraged by the far right.
Winning hearts and minds is the first step at bringing a more rational approach to the treatment of chronic pain. Most of our doctors are behind us on this issue, and with law enforcement now being directed back to the real threat, doctors can begin coming out in support of a more rational and science-based justification when treating chronic pain.
One of the first items on that agenda of change should be an effort to force state prescription drug monitoring programs to publish data showing the links between opioid overdose deaths and legal prescriptions issued to such individuals. If those facts are anything like the data released by Massachusetts in 2019, then there should be overwhelming evidence to show that opioid overdose deaths, while contributed to by prescriptions, is still far from being the real cause for the opioid crisis.