Mitigating the Opioid Crisis

Mitigating the Opioid Crisis.

I am not unacquainted with persistent aches and pains of a body living into its ninth decade.  However, only once have I been given a prescription for an opioid, Oxycodone.  It was enough for ten days following a surgery on my foot.  I discovered I needed to take only one half of the recommended dose and for only five days.  I’ve been very fortunate.

I have also witnessed the pain of others, both physical and mental as an army medic in the early 60’s at Walter Reed Army Medical Center.  There was ongoing discussion about the appropriate use of drugs and their observed side effects on patients.  For eighteen months I was selected to work on a research ward where the psychiatric treatment program was drug-free.  This project was contrary to the prevailing trend to rely on the surge of new psychotropic drugs. We experienced results that matched and exceeded the dependence on drug therapy.

I know that some prescription drugs can be life-saving while others contribute to a reduction in chronic pain leading to a more comfortable and fulfilling life for many people.  I do not advocate restricting doctors from prescribing drugs to alleviate persistent pain. However, even with my experience over the years to be judicious in the use of drugs, I’m now subjected to daily multiple TV ads showing people who have taken a prescription drug experiencing happiness, wealth, and health while enjoying life with colleagues, friends, and family.  An authoritative voice in the background affirms, all you need to do to be like these people is to “ask your doctor about…” a particular drug.  The commercials tempt us to use drugs as the vehicle for the good life.  In one two-hour evening I’m told to ask about nine different prescriptions.  I’ll give their generic names to avoid promoting the familiar brands:  secukinumab, adalimumab, diphtheria CRM 197, sacubitril/valsartan, rivaroxaban, crisaborole, apixaban, etanercept, and cariprazine.

Not surprisingly, the push by drug companies to normalize the dependence upon drugs of many kinds is driven not so much for health as for financial gain. PBS Evening Edition recently reported the company, Purdue Farmer, that formulated and produces the opioid, Oxycodone, is being sued for its efforts to continue to expand sales in spite of the growing opioid crisis.  The report includes a Purdue board member urging efforts to increase sales by arguing, “The important thing is increasing the company’s bottom line, not taking responsibility for the dangers of the drug or the people who abuse it.”

I have also received an email letter from Senator Jeanne Shaheen announcing she has introduced legislation, the End Taxpayer Subsidies for Drug Ads Act.  This bill focuses on drug prices and drug company profits.  She points out that drug companies are allowed to deduct from their federal taxes the billions of dollars spent on advertising.  This loophole in the tax code encourages drug companies to inundate the airwaves with tax free commercials.  “Aggressive advertising increases demand so that drug companies can continue to hike up drug prices,” Shaheen explains. “This scheme yields an incredible windfall for the drug companies and it needs to end.”

Discouraging the deluge of TV drug commercials has several effects.  Senator Shaheen seeks to reduce the cost of prescription drugs by decreasing the demand for them.  Another effect of fewer drug ads would be the weakening of the subliminal message that drug use is a normal and common-sense way to live and solve all of our problems, rather than using drugs only for exceptional and special situations. Finally, there would be fewer temptations to seek a drug for every eventuality.  Normalized drug usage has been an easy enticement into using opiates to improve a person’s life.  As these enticements fade with fewer drug ads, so will a significant cause of the opioid epidemic.

Therefore, one way to confront the opioid epidemic is to limit the dissemination of drug ads on TV and other media.  (This has been done with liquor commercials for years, although they are creeping back in occasionally).  Supporting the passage of Shaheen’s bill to End Taxpayer Subsidies for Drug Ads Actmay not only take away a subsidy from wealthy drug companies and reduce drug prices.  It may also put an end to the normalization of excessive drug use.  The bill could free people from the inducement to “Ask your doctor about” a particular drug and instead open the conversation to, “ask your doctor about choices of treatment appropriate for your particular situation.”  And it may contribute to the mitigating the opioid drug crisis.

 

Unintended Consequences

Unintended Consequences

I have a friendship with a family of Mexican heritage.  The father is a naturalized citizen of the United States. While sitting around the dinner table, they tell me they are reluctant to cross into Mexico to visit relatives because they fear the father may not be allowed to return to the U.S.  I’ve had meals with a Palestinian family, living in Azun, who describe how they are sometimes restricted from passing through an Israeli checkpoint to go to the nearest church in a neighboring village. I’ve walked the migrant trail from Mexico to Tucson, Arizona.  Along the way we passed near the Tohono O’odham reservation that straddles the U.S. / Mexican border.  The native Americans can no longer cross the border wherever they please on their land. They have to go through specific entry points.  These experiences have introduced me to unintended consequences of barrier and border walls ostensibly built for security.

Since 2002 Israel has been building walls and barriers on occupied Palestinian territory in the name of security.  Sometimes these walls stand around the edges of illegal Israeli settlements on Palestinian land.  Others, also on Palestinian land, are built as much as 3 miles inside the green line established after the 1967 conflict.  Often there are barriers between a Palestinian village and the farmland of the village.

Since 2006 the Secure Fence Act, the U.S. has been installing fence along the Rio Grande river in the county around Brownsville, Texas.  A lot of it is half a mile or even a mile north of the river so it cuts right across private lands.  A member of the Tohono O’odham nation reflects on the situation of the reservation that straddles the border between Mexico and Arizona, “We’ve never crossed the border; the border crossed us…  We feel betrayed back for 160 years when this international boundary was created, without any consent or any discussion.”

I read a recent opinion that the United States should take a lesson from Israeli wall-building as a way to secure our nation.  A letter to the editor in the Monitor on January 8 suggested that walls have been built down through history as a solution to security. A letter to the editor in the Monitor on January 16 pleads for the building of a barrier along the Mexican border to stop drugs from “invading New Hampshire and destroying our state.” Our president calls wall building, “common sense.”  However, this “common sense” advocacy for wall-building as a security measure does not recognize the ancillary consequences.

One of the most self-defeating results of wall building has been to isolate neighbors from one another.  The elders in the Palestinian village of Jayyous, where I lived forthree months in 2010, often lamented the loss of contact with Israeli neighbors in the villages where they had lived before 1948.  Since the Palestinians had been forced out of these villages, it had become more and more difficult to maintain communications with their Israeli friends. There is no opportunity to learn and experience the struggles and joys of their respective daily lives.  Opportunities for understanding and empathy are no longer possible.

While walking the migrant trail from Mexico to Tucson, I listened to a rancher who lives along the U.S. / Mexico border in Texas.  He talked about how the life of his town has changed since the expansion of border barriers and security patrols.  He harkens back to the time when the checkpoints were open 9-5 and the rest of the time people traveled unhindered back and forth for visits, shopping, entertainment, and jobs.  With increased barriers, neighbors across the border are no longer able to meet together. Fear and suspicion of “the other” is growing.  Also, some of the private ranchland in the United States is now inaccessible because walls and barriers pass through it.  Barriers block cattle’s access to the water of the river.

Today the Tohono O’odham people can no longer cross the border wherever they please. They have to go through specific entry points.  New walls become “an obstacle in our path in life to go visit family, to go visit friends, to go to sacred sites in Mexico… To put a border wall here would be detrimental to our people. It would have a psychological effect. You would have an emotional effect. I think you wouldn’t like it if I dug a wall right through your home. This is our traditional homeland.”

As our president and congressional delegation haggle over the building of the wall between the United States and Mexico these unintended consequences should be included in the debate. Consequences of magnified mistrust, fear, distorted rumors, and fabricated enemies are moral issues.  Economist Alex Tabarrock in an Atlantic essay in 2015 wrote, “What moral theory justifies using wire, wall, and weapon to prevent people from moving to opportunity?” RepresentativeNancy Pelosi got it right when she declared the building of the wall, “immoral.”

Every conversation with a politician about the border is prefaced with, “I’m in favor of strong border security.”  However, the ensuing conversation never seems to include our values and moral compass as guides and instruments to security.  Considering ways to build friendships and allies rather than defining and excluding enemies could create more freedom as well as enhanced security.  It could make it possible for my friend of Mexican heritage to travel with confidence to visit relatives across the border.  It could free the people along our border totravel unhindered back and forth for visits, shopping, entertainment, and jobs.  It could re-unite people of the Tohono O’odham nation and heal their anxiety.  And it could increase our sensitivity to the oppression experienced with the wall and barrier building in Palestine/Israel.  It’s time for unintended consequences to prevail against obsolete wall building.

 

 

 

 

 

 

A Haiku on occasion of government shutdown

Workers without pay.

Winter snow hides D.C.’s grime –

Uncle Sam keeps slaves.