Education, Law Enforcement, and Treatment Programs Are Key

Pharmacy TimesSeptember 2019 Pain Management
Volume 85
Issue 9

All 3 are essential in the fight against the opioid crisis, but they need to forge alliances and work together.

I have read countless articles over the past few months about how we can better address the overwhelming number of opioid overdose deaths, including from prescription opiates. We should be wary, however, as people have been claiming to have the answers for the past 50 years, to no avail.

In the late 1960s and early 1970s, many abused prescription drugs. Heroin abuse, also rampant, was concentrated in heavy urban areas and primarily affected African Americans. Because the heroin purity levels hovered at less than 10%, the only way to get a decent high was through injection. Many also sustained their addictions using oxycodone and hydromorphone pills they scammed or bought through dealers. Exchanging prescription opiates for heroin was common, too, along with selling pharmaceuticals to obtain funds to purchase heroin.

Most of this heroin came from New York City, transported through areas of the country that did not have drug-sniffing canines and interdiction units. The possibility of being stopped and drugs being found in a vehicle was much less likely than it is today.

Later, cocaine dominated the drug abuse culture, followed closely by crack cocaine, or hard cocaine. This form was thought to be more addictive, and laws related to crack were strengthened, causing some to feel that African-American communities were being targeted. But the truth is, all kinds of people abused crack, and there was plenty of crack production and illegal use in predominantly white communities.

From the late 1990s into 2010, prescription drugs seemed to be the main drug problem on America’s streets. OxyContin, although a great drug for pain, was being broken down for injection and snorting. Then, around 2010, Mexican cartels found that illegally importing carfentanil, fentanyl, and heroin could again be very profitable in the United States. In particular, the Midwest has experienced a recent flood of cocaine and crystal methamphetamine. The wave of unintentional overdose deaths from all these illegal substances continues today.

The effort to deter the epidemic of drug abuse has been 3-fold: education and prevention, law enforcement, and treatment programs. Government funding has favored each of these 3 legs of the deterrence stool at various times over the past half century.

Many times, law enforcement has received large amounts of government money to address the drug epidemic, although many people say we cannot arrest our way out of this crisis. Law enforcement clearly knows this, but pursuing and arresting drug traffickers is still extremely important. Beat officers, drug task forces, intelligence gathering, interdiction, and undercover operations are all invaluable.

Treatment has also received massive amounts of funding over the years. Methadone programs developed in the very late 1960s continue today and allow countless addicts to lead somewhat normal lives and become productive members of society. More recent work with buprenorphine and drugs such as Vivitrol (naltrexone) is also showing signs of reducing addiction. Drugs used to treat addiction must be coupled with counseling, of course.

Last, but certainly not least, are the education and prevention folks. Their jobs can be exhausting, as they also fight for dollars to keep their programs running.

Measuring prevention methods is not easy. Even if addiction rates rise, does that mean the education and prevention methods used were failures? I believe that addiction rates would be even higher without education and prevention. Education and prevention methods in our jails should be stepped up.

The truth is, all of these groups are key to reducing the drug problem. Unfortunately, many times they fight each other over who should receive the most funding. I would like to see the 3 find new ways to forge alliances to make a difference.

Cmdr. John Burke is a 40-year veteran of law enforcement, the past president of the National Association of Drug Diversion Investigators, and the president and cofounder of the International Health Facility Diversion Association.

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