CLEVELAND — On Thursday night, two doctors and a drug law expert met in Cleveland. Their task? Come up with novel ways to fight an epidemic that kills 150 Americans every day.
America’s opioid crisis has become day after day of overdose stories, stunning photos, or new chemistries that are potent enough to kill even elephants. Cleveland Clinic’s CEO, Dr. Toby Cosgrove, former US Surgeon General Vivek Murthy, and Drug Enforcement Administration administrator Chuck Rosenberg sat down at a public forum Thursday night to strategize.
Here’s a snapshot of what they said.
‘We have a war going on in our country on an annual basis.’
Cosgrove started the discussion with a graphic showing that 52,000 people died of drug overdoses in 2015, a more than twofold increase since 2002. A Vietnam veteran, he also pointed out that the death toll is nearly equal to the total number of Americans who died during the Vietnam War, which claimed 58,000 lives. He suggested that a more visual, in-your-face representation of the problem might stir action.
“I don’t think people recognize the magnitude of the problem,” Cosgrove said. “They don’t realize the seriousness of the drugs — the fentanyl and carfentanil. … The war in Vietnam was stopped by raising the consciousness of the American people. They saw the body bags coming into Andrews Air Force Base every night on the evening news. You don’t see that with this problem.”
‘It’s killing people sometimes on the first encounter.’
Rosenberg said two powerful opioids, fentanyl and carfentanil, are being laced into a variety of drugs, often without the knowledge of the user. It is not just getting mixed into heroin, he said, but cocaine and counterfeit prescription pills as well.
They are simpler to make, Rosenberg said, and even easier to sell. “The profit margin is immeasurably higher with fentanyl and carfentanil,” he said. “We are seeing it in many iterations all over the country.”
Fentanyl is 50 times stronger than heroin and carfentanil is 100 times stronger than fentanyl — merely handling them can cause an overdose. To protect its agents, the DEA has trained 1,100 of them to administer naloxone in case of an accident. Rosenberg referenced an incident in East Liverpool, Ohio, in which a local police officer overdosed after brushing some powder from his shirt after a drug stop. “It took four injections of naloxone to help save his life,” Rosenberg said. “This stuff can kill you to the touch.”
‘Health insurance coverage is essential for people to get treatment.’
Murthy did not mention the Republican-led American Health Care Act by name. But he noted that any reduction in coverage would be a major setback in the effort to fight the opioid crisis. The Congressional Budget Office estimated this week that the House’s Obamacare replacement would leave 23 million people uninsured over the next decade.
“If you are serious about addressing the opioid crisis in America, you have to be serious about expanding coverage because those two go hand in hand,” he said. Murthy urged members of the audience to contact members of Congress to urge them to push for greater coverage and other measures to expand access to naloxone and long-term treatment for drug users.
“These measures might be hard and politically controversial,” he said. “But this is a time when we need moral leadership in our country more than ever before.”
‘We’re not going to enforce our way out of this.’
Rosenberg emphasized that opioid addiction is a disease that must be treated with medicine, not incarceration. He said the DEA is getting increased cooperation from China to help stem the flow of synthetic opioids, and that his agency is targeting drug gangs and cartels that are distributing drugs. But he also emphasized that the public policy response must also focus on the demand side, to uproot addiction through education and treatment.
“This is a public health crisis and we have to change the culture,” he said. “If we don’t change the culture, then we don’t break the cycle. If we don’t break the cycle, this poison will continue to flow into the United States and kill our folks.”
He added that policy decisions should be guided by science, not opinion or ideology.
‘We need to find safer ways of addressing pain.’
Murthy said that clinicians must change the way they respond to pain, and be trained in other ways of treating it — like cognitive or physical therapy. “Part of the issue is that we would assess pain and then set a goal of having zero pain,” he said. “And opioids became our most effective tool to eliminate pain entirely. … But there are circumstances where eliminating pain entirely may not be our most important objective.”
Murthy added there is still a widely held misconception in the United States that addiction stems from a character flaw or results purely from poor choices. He said a culture shift is in order: “This is a disease of the brain and that has been well demonstrated by science. Once we recognize that, we can treat it the way we treat diabetes or heart disease, as a medical problem the deserves the same care, the same compassion, and the same urgent attention.”