There was at least one matter of vital global interests that Prime Minister Justin Trudeau and U.S. President Donald Trump agreed on when they met recently in Washington, D.C. -- that the opioid crisis sweeping North America was unprecedented, that opioid deaths had shot up in both countries and that opioid trafficking knows no borders. International collaboration is essential.
U.S. President Donald Trump (R) walks with Canadian Prime Minister Justin Trudeau after a meeting at the White House on Feb. 13, 2017 in Washington, D.C. (Photo: Mark Wilson/Getty Images)
According to an April 2016 Kaiser Family Foundation survey, fully one-third of Americans who are given prescription opioids become addicted within two months. Roughly 11 per cent of 48,000 random Internet users across 60 countries surveyed by our data firm in November said they knew a friend (even if a distant friend) or family member who had died of an opioid overdose in the past year. In Canada, the figure is 15 per cent. In the United States, where more than 55,000 people died of drug overdoses in 2015 (a higher tally than gun homicides), it is 19 per cent.
The main culprit for the spike in the death rate is no longer heroin but fentanyl, a synthetic drug up to 50 times as strong as heroin. Fentanyl's spread has brought the world face to face with what has turned into a pandemic.
Amidst hundreds of opioid class action lawsuits in the United States and Canada filed on behalf of users of a wide number of prescription pain pills, there is an inescapable public health fact that eludes the well-intentioned rhetoric of law enforcement and policy makers. It is this: the challenge is more complex than fentanyl or any one opioid. The pandemic adapts to selective pressures; ever-new combinations of drugs are forever in kitchen production. Many effects of drugs are synergistic: benzodiazepines and opioids can be fatal when combined.
Opioid abuse accounts for a climbing suicide rate and widespread economic malaise.
Even drugs used to treat opioid addiction are being abused and combined with traditional opiates, leading to deadly consequences. Examples are methadone, a long-acting opiate, and suboxone, a partial agonist of opiate receptors.
Few scientific labs have the wherewithal to detect minute (but lethal) traces of fentanyl in street pills. And a sinister analog, carfentanil, is increasingly seeping onto the streets affecting young and old. The elderly, unexpectedly, are among the fastest growing segment of drug abusers, but no one is immune. Across suburban America, opioid abuse accounts for a climbing suicide rate and widespread economic malaise.
Doctors have been admonished for prescribing too many opioids, but should reining in doctors be the paramount policy solution? What about patients in pain? According to a recent report in the Washington Post, pharmaceutical companies in Brazil and China are bucking the trend by running training seminars urging doctors to prescribe more painkillers rather than less.
Fentanyl citrate in the secure area of a local hospital Friday, July 10, 2009. (Photo: Joe Amon/The Denver Post via Getty Images)
The public is left frustrated and confused. Meanwhile, many physicians are addicts themselves. Today, approximately 10 to 14 per cent of all U.S. doctors will become substance-dependent over their lifetime. Physician recovery programs are instructive since their success rate is close to 90 per cent, the highest of any recovery programs. The physician needs to sign a five-year agreement that entails regular recovery meeting attendance, individual and group therapy and random drug testing. The goal is to provide a supportive framework long on accountability but short on stigma.
We should reject a political and legal climate that makes physicians stop prescribing opiates to people in pain. A "just-say-no-to-prescribing-opiates" policy pushes patients onto the street where each buy is a game of Russian roulette; the ingredients of street drugs are essentially unknown.
We need Trump's touted deal-making skills and Trudeau's compassionate stance toward drug users to promote a global solution.
The introduction of fatal synthetic fentanyl doses into street pills marks new terrain in the illicit drug trade around the world. The war on opioids now requires the coordinated expertise of cyber engineers, law enforcement agents, economists, clinicians, patient groups and public health officials. Vague policy recommendations (shame and scare tactics) that may or may not have worked in other contexts are risible in this pandemic.
President Trump plans to tackle America's addiction epidemic by increasing drug treatment access and controlling illegal immigration. He wants to close shipping loopholes that allow China to ferry fentanyl into the United States. But the amount of fentanyl (think of half-finger-sized vials) needed to infect synthetic legal pills and thereby addict a whole neighbourhood in a mega-city is so tiny and so undetectable that even very strong borders are not sufficiently protective.
We need Trump's touted deal-making skills and Trudeau's compassionate stance toward drug users to promote a global solution that confronts the opioid pandemic as if it were the plague. We conduct research. We gather epidemiological data. We block the spread. We educate the public. We get rid of the conduits. We care for the sick.
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