The Root Cause of America's Opioid Crisis: Doctors are Not at Fault
The prevalent issue known as the "opioid epidemic" in the United States has tragically led to nearly 100,000 deaths in 2021 due to overdoses involving narcotic drugs, and in some cases, alcohol. Advocates against opioid use often wrongly attribute this crisis to physicians' "over-prescribing" of opioid painkillers to patients. However, these claims are factually incorrect. Addressing these misunderstandings requires significant shifts in U.S. national healthcare policies and legal approaches.
It is important to clarify that doctors prescribing medications to their patients did not initiate the opioid crisis in the U.S.
The nation is undoubtedly facing a critical public health emergency, marked by escalating rates of drug addiction and tens of thousands of deaths each year due to drug overdoses. Yet, it is crucial to understand that doctors are not responsible for causing this crisis by over-prescribing opioid pain relief medications. The core driver of our "crisis" is the proliferation of illegal street drugs, primarily fentanyl, sourced from Mexico and China.
As early as 2016, Dr. Nora Volkow, the director of the National Institute on Drug Abuse, along with Thomas A McMillan, emphasized that addiction is not an expected outcome of opioid prescription. A small proportion of individuals exposed to opioids, even those with pre-existing vulnerabilities, develop addiction.
The true crisis stems from socio-economic determinants of health, rooted in 50 years of stagnant wages, escalating wealth disparity, inadequate investment in national economic infrastructure, and the erosion of rust belt, rural, and inner-city communities due to systemic poverty. The collapse of familial support networks contributes to vulnerability to addiction, which is a consequence of living conditions rather than medical exposure.
Unfortunately, these realities are often misconstrued by organizations such as the Centers for Disease Control and Prevention, the Veterans Administration, and law enforcement bodies, particularly the Drug Enforcement Agency. Despite claims linking prescription to opioid-related deaths, data from the CDC itself contradicts such allegations.
For many Americans, prolonged opioid therapies are vital for managing severe pain and maintaining a reasonable quality of life. Paradoxically, current U.S. public health policies inadvertently contribute to a high number of patient fatalities by pressuring doctors to withdraw from pain management and pushing patients towards illicit markets or even suicide.
Recognizing that doctors are not and likely never were the primary catalysts of America's opioid crisis reveals the glaring shortcomings in existing public policies regarding addiction, overdose fatalities, and harm minimization.
Immediate Necessary Actions:
The opioid crisis in America is multi-dimensional, and thus, healthcare policy redirections must be comprehensive, potentially requiring new legislation.
Federal-level Corrections:
Swiftly disavow and reject the flawed and hazardous 2016 and 2022 revised CDC guidelines for opioid prescription. Notify State Medical Boards and Departments of Health that these guidelines should no longer inform State healthcare regulatory documents.
Publicly renounce the May 2022 "Clinical Practice Guideline for the Use of Opioids in the Management of Chronic Pain" and the related "Opioid Safety Initiative" from the Department of Veterans Affairs and the Department of Defense. Both documents suffer from the same cherry-picking and misrepresentation of research evident in the CDC guidelines.
Amend the Controlled Substances Act of 1970 to cease pre-trial asset seizures targeting clinicians. Coercing clinician staff to testify against clinicians with the threat of prosecution must also halt.
An immediate cessation order to the Drug Enforcement Agency is essential, suspending the prosecution of clinicians until definitive standards for judge and jury instruction under the 2022 Supreme Court decision in Ruan v. the United States are established. These standards must be accompanied by a related criterion for the qualification of "expert witness" testimonies against clinician defendants.
Given the current scarcity of vital anesthetic and analgesic medications due to DEA interventions, the DEA's authority to set production quotas on scheduled medications should be revoked.
State-level Actions:
All states should replace laws that restrict patient access to opioid medications under medical supervision or penalize clinicians for prescribing opioid pain relievers based on their best judgment of patient needs. Recent legislation enacted in New Hampshire, Rhode Island, Oklahoma, Arizona, and Minnesota provides models for policy recalibration.
Substitution of CDC and VA Guidelines:
The FDA or National Academies of Medicine should convene a year-long consensus conference on clinical standards for acute and chronic pain treatment. This conference should have the backing of clinical specialty academies and Boards, and participants should possess hands-on professional experience in pain management across hospital and community settings. Voting members should also include chronic pain patients or their advocates. An interim draft should be made public for comments through the Federal Register. Responses to each comment must be tracked and reported, following the model established by the 2018-2019 Department of Health and Human Services Inter-Agency Task Force on Best Practices in Pain Management to ensure transparency and scientific rigor.
A Plea for Assistance and a Call for Change:
Numerous U.S. citizens grapple with daily lives filled with pain. Much of this suffering arises from misguided public health policies and deceptive misrepresentations of the benefits and risks of prescription opioid medications. Even officials who inherited this crisis must acknowledge that they are either part of the solution or part of the problem.
A clear message to governmental decision-makers: Our silence will no longer prevail. We demand immediate actions on our behalf.
