One of the many “alternative facts” posed by the Trump administration targets the biggest contemporary public health issue in the United States: the opioid epidemic.
On Feb. 23, press secretary Sean Spicer linked the opioid epidemic to recreational marijuana use. This is part of an attempt by the Trump administration to enforce federal regulations on marijuana, even in states where it has been decriminalized.
This decision would insist upon federal control that would overrule state decisions. This is after his spokesman Spicer stated “the president has made it clear throughout the campaign that he’s a firm believer in state’s rights” when rescinding federal protections for transgender students that allowed them to use the restroom that corresponds with their gender.
Is there any truth to Mr. Spicer’s claim? Evidence seems to contradict him.
A report in the prestigious journal JAMA Internal Medicine presented a study of opioid overdose deaths analyzed by state between 1999 and 2010. The study revealed lower overdose death rates in states with laws permitting medical marijuana and that as states passed such laws over the 12 year period, the rates in those states declined.
This does not disprove Spicer’s claim, and it is all but impossible to construct a direct proof that the claim is false, but if we explore the genesis of the opioid overdose problem as it has emerged over the past 25 years, we can conclude that marijuana use, medical or recreational, plays little or no role.
Pushing unsupported claims about the cause of the opioid crisis to support an agenda is irresponsible of Spicer and the Trump administration, since this will do nothing to ameliorate the current issue and will instead do more harm.
Instead, let’s review the ample research that supports the idea that the epidemic arose from poor control of opiate prescriptions leading to an over-prescription of drugs.
The opioid issue is important and too significant to allow decisions to be made by spreading falsehoods and misconceptions. Opioids killed over 33,000 individuals in 2015; half of those have been attributed to prescription opioids. Per the Center for Disease Control and Prevention, this is the equivalent to 91 individuals dying each day.
In Connecticut, there was a total of 2,569 deaths caused from accidental opioid overdose between January 2012 and June 2016; and 441 of these deaths occurred within the first six months of 2016. In this four-year time span, there was a 260 percent increase in opioid-related deaths in Connecticut. Most of these accidental deaths occurred at a place of residence.
To best reverse the current problem, one must evaluate all underlying systems that give rise to opioid addiction. One must identify current research that focuses on the factors that can control and lessen the epidemic, and one must use that research to design effective interventions. Subsequently, one must seek contributions from stakeholders. These stakeholders can include affected families, educators, journalists, health practitioners, and policy makers.
The Trump administration can positively contribute to the fight against the opioid epidemic, but a focus on marijuana policy is not helpful since research shows a very different story. Relaxed policy on opioid prescriptions for non-cancer chronic pain beginning in the 1990’s helped drive the epidemic. Simultaneously, there was a powerful marketing campaign that was pushed by opioid pharmaceutical companies that led to a significant increase in opioid sales. With increased opioids, individuals can access them not only through a doctor prescription, but also through friends and dealers.
If President Trump and his administration really intend to help individuals suffering from this widespread disorder, then there are much more effective approaches than railing against marijuana. More support can be provided for harm-reduction programs such as those that provide needle exchanges, and naloxone kits.
Harm-reduction programs can help reduce the number of opioid related deaths: needle exchanges help prevent transmission of communicable diseases, and naloxone distribution programs help prevent deaths due to opioid-related overdose. Many of these programs exist with the help of federal funds so they can benefit from financial support from the Executive branch.
The administration can help expand the discussion about opioids. This is important because opioids are still an effective treatment for different types of pain. The issue is not that they are being used, rather it is how they are being used. They are best administered to individuals who are dealing with acute pain issues such as the pain that results after trauma or surgery. These are pain issues that can be resolved with time so they do not foster dependence to the opioid drug. Opioids should not be administered to individuals that suffer from non-cancer chronic pain.
President Trump can support Medication Assisted Treatment (MAT) by promoting bills like Senate bill 17-074. This bill focuses on expanding access to MAT, an addiction-centered rehabilitation program that incorporates both medication and behavioral therapy and that has proven to be clinically effective. Here in Connecticut, many clinical organizations, such as the APT Foundation, the Hartford Dispensary, and Recovery Network of Programs, have successfully run MAT programs in various sites.
There is a widespread belief that treatment through abstinence is the best way to overcome addiction, but this is not true. These abstinence methods are based on the Alcoholics Anonymous (AA) model of therapy, formally known as the “Minnesota model.”
This model relies on will-power and belief in a higher power. However, this model (and the popular AA program itself) has faced many challenges which ultimately lead to a relapse. Thus, this model has a high failure rate. To prevent these repeating failures Dr. Bankole Johnson, professor of neuroscience at the University of Virginia, suggests “people should demand more evidence-based treatment.”
Currently, research supports Medically Assisted Treatment. Opioid addiction is a disease and it causes changes in the physiology of users and these changes must be treated with medication. The medication proponent of MAT is more than an assist, it is central to treatment effectiveness notes Dr. Robert Heimer of the Yale School of Public Health.
One would not treat lung cancer with an abstinence from cigarettes; medication needs to be used to treat the lung after it has been damaged from smoking. Unfortunately, none of these points were mentioned by Spicer during his press-conference.
The opioid crisis is too important to be used as a weapon to push a different agenda. Correct information needs to be disseminated to educate people so they can seek proper treatments. There are various ways the Trump administration can help to reduce the epidemic, but it needs to focus on current research and effective treatments.
Instead, he has proposed to cut agencies like the National Institutes of Health that would fund such research. Most of the ways that the administration can help to alleviate the epidemic involve supporting health departments, federal research agencies, and the proper legislation.
If President Trump truly wants to address the current crisis, then he should have Spicer present plans that will help fund research, overdose prevention organizations, and MAT centers instead of having him speak about an unsupported claim about marijuana use. This monetary support would truly benefit the people he claims to care about. This is especially true since the red states that supported his campaign him have been most heavily affected by the epidemic.
President Trump has a lot to do to effectively address the opioid epidemic, but he does not have to do it on his own. Public health scientists, harm-reduction organizations, and MAT centers have dedicated their resources to the fight against the opioid epidemic; President Trump must support them politically and financially.
Focusing his attention on a link between marijuana and opioids that lacks scientific support is counterproductive. This is unfair to the millions of victims who have suffered through the epidemic alongside their families and friends.
Emmanuel Gaeta is a student of public health at Yale University.