There are many issues facing our country today. The most pressing of which is the opioid epidemic. The facts of the matter prove just how deadly this is, and because of the Iron Triangle, it is nearly impossible to begin to fix the problem.
To know where we must go in the future, we must first look back on the history of opioids and pain-relieving drugs in America. The first widespread use of morphine came during the US Civil War when it was used as a battlefield anesthetic. Many soldiers became dependent on the drug resulting in the nickname for opioid addiction as the “Soldier’s disease.” Towards the turn of the century, hundreds of thousands of Americans, mostly veterans, have become addicted to the drug. Around this time, the company Bayer began commercially producing heroin, and at the time it could have been bought through the Sears Roebuck catalog. Due to limited knowledge of the new drug, heroin was thought to be less addictive than morphine and was distributed to individuals who were addicted to morphine in an attempt to help them get off the drug.
In 1906, the United States Congress passed its first national drug law requiring the labeling of drug ingredients in over-the-counter medications such as opiates. In 1914, Congress passed the Harrison Narcotics Act, which required that doctors write prescriptions for narcotic drugs like opioids and cocaine. This also required that importers, manufacturers, and distributors of narcotics must register with the Treasury Department and pay taxes on their product. The Taylor 2Narcotic Drug Import and Export Act was also created to control the importation of narcotics, except for medical use. Then in 1930, The Federal Bureau of Narcotics was created and two years later, successfully lobbied for the passage of the Uniform State Narcotics Act that encourages states to pass laws matching the earlier passed Narcotic Drug Import and Export Act.
Finally, in 1956 the World Health Organization and the American Psychiatric Association identified drug abuse as a disease. This is seen as a big milestone as it takes away some of the stigmas many addicts have been living with. By the late 1960’s one of America’s first pain-relieving drugs, heroin, becomes the first modern drug epidemic. This resulted in The Alcoholic and Narcotic Addict Rehabilitation Amendments of 1968, authorizing federal funding for the construction and staffing of treatment facilities for addicts.
Two years later, Congress passed the Comprehensive Drug Abuse Prevention and Control Act, which merged all of the drug laws. This strengthened law enforcement’s authority and penalties for the illegal trafficking of controlled substances, and it expanded the national drug abuse program by broadening the definition of a drug-dependent person. It also provides funding for research on drug abuse and treatment and rehabilitation of drug abusers. Then in 1986, President Ronald Reagan signed the Anti-Drug Abuse Act to create mandatory sentences for drug-related crimes.
This persuaded addicts to not receive help because they believed that they would be arrested and charged. Later in the early 1990’s Congress strengthened the Anti-Drug Abuse Act to impose strict record-keeping regulations on pharmaceutical firms. While this was meant to regulate the pharmaceutical industry, their lobbying and big pockets were able to curtail lawmakers from actually following through with their promises.
During this time, Purdue Pharma released Taylor 3OxyContin and aggressively marketed it as a safer pain pill than its competitors. In 2002, a survey by the Substance Abuse and Mental Health Services Administration showed that approximately 22 million Americans suffer from substance abuse or dependence. That same year, a Monitoring the Future survey showed a decline in overall drug use among teenagers, but an increase in the abuse of prescription painkillers.
In October of 2004, The George W. Bush Administration unveiled the National Synthetic Drugs Action Plan to target synthetic drug abuse of prescription medicines, club drugs, and methamphetamines. A year later, The National Center on Addiction and Drug Abuse at Columbia University reported that prescription drug abuse had reached an epidemic level in America. Despite this, the government failed to take any substantial action in order to address this issue.
In 2007, the federal government brought about criminal charges against Purdue Pharma for misleading their advertising of OxyContin as safer and less addictive than other opioids. The company was charged with “misleading and defrauding physicians and consumers.” The FDA started working with pharmaceutical companies to approve an “abuse-deterrent” formulation of OxyContin, but it didn’t make much of a difference as individuals are able to find ways to abuse it. In 2015, after a 15-month sting operation centered on health care providers who dispense large amounts of opioids, the DEA announced that they have arrested over 280 people, 22 of them being doctors and pharmacists. This is the largest prescription drug bust in the history of the DEA. A year later, the CDC presented guidelines for prescribing opioids to patients with chronic pain, suggesting that doctors prescribe over-the-counter pain relievers and promote exercise and behavioral treatments to help patients Taylor 4cope with pain instead of opioids.
In 2017, President Donald Trump declared a National Public Health Emergency to try and combat the opioid crisis. When a president declares a National Health Emergency, many look to see if there is any substance to the claim. The declaring of the National Health Emergency means multiple things for combatting the crisis. This opens up funding to further study the crisis, it expands access of tele-medicine to rural parts of the country, and it instructs agencies to curb bureaucratic delays for giving out grant money while also shifting some federal grants towards beating the crisis.
There is no room for fake national health emergencies because the funds and grants that go towards this are coming out of other important projects around the country. While there have been some skeptics, there is no doubt that we are in a national health crisis. In fact, we are in the deadliest drug crisis in United States history.
In 2015 alone, drug overdoses killed 52,404 people, more than gun homicides and car crashes combined. While prescription drug overdoses killed 30,114 of that 52,404 (with heroin accounting for the remaining number) it is important to link these numbers together because 86% of heroin users used opioid painkillers prior to using heroin. This correlation is extremely troubling as it is hard proof that the powerful opioids are pushing users towards chasing a more extreme high. Many addicts also switch to heroin due to the fact that it is cheaper than prescription drugs with its price being $465 dollars per pure gram in 2012.
It is much cheaper than opioids found on the black market. Due to a 2003 law, the government can’t seek bids for companies to manufacture the drugs and this results in opioids costing much more than other drugs, and is just another way that addicts are pushed towards Taylor 5heroin. Another troubling statistic is that between 1999 and 2015 more than 560,000 people died of drug overdoses, and some communities have been hit much harder than others.
States like New Hampshire, Rhode Island, and Ohio have been hit particularly hard, each having over 22 opioid overdose deaths per 100,000 people. West Virginia has been disproportionately hit the hardest with around 34 deaths per 100,000 people. These numbers are far higher than the average of 15 deaths per 100,000 people. The major force of the epidemic has mainly been concentrated along the Rust Belt and New England areas largely due to the tremendous number of painkiller prescriptions that doctors give out in these areas. American doctors as a whole have prescribed opioids way to prominently with the 259 million prescriptions in 2012 being enough for every American adult to have their own bottle of pills.
Only 2 years later, 12.7 billion pills were prescribed of hydrocodone and oxycodone alone. Last year, the United States used over 80% of the world’s opioid supply despite accounting for only 5% of the world population. There are even 13 states that prescribe more opioids than people living in it. This goes to show the extent in which opioids are being overused and over-prescribed in our country with 99% of doctors in 2016 prescribing opioids that exceeded the federally recommended three-day dosage. Despite this, only 3,000 prescribing licenses have been taken away since 2010, and only 10 states have legislation that limits opioid prescriptions to 7 days or less. Painkillers are often prescribed for long periods of time, even though there’s no evidence that they effectively treat chronic pain.
Prescribing painkillers for long periods of time is quite dangerous and results in a higher risk for addiction, overdose, and death. A recent study conducted by the Centers for Disease Control and Prevention showed that the risk of dependence on opioids increases greatly for each day Taylor 6someone is prescribed one. A big problem that the addicted have is the stigma that comes with being an addict, and according to 2014 federal data, 89% of people who met the definition for having a drug use disorder didn’t get treatment and that data excludes homeless individual and those incarcerated (who are more likely to have serious drug problems as well). One of the biggest problems that led to this is the fact that anyone is able to become an addict. Only one prescription can grow that addiction, and studies show that no matter what your race or gender is, no specific demographic is less prone to addiction. There are three points to the issue and they come in the form of the Iron Triangle. The Iron Triangle is made up of interest groups, Congress, and bureaucracy. In regards to the opioid crisis, the interest groups are the pharmaceutical companies.
Interest groups work towards gaining favor by providing electoral support for certain candidates along with lobbying and financial contributions. The pharmaceutical companies have given great deals of money and have gained control of politicians to be able to push their agenda. Through this money, they are trying to get Congress to pass laws that are more favorable to them and that allow them to function in a more free environment. Over the past decade, these interest groups have given around $2.9 billion in lobbying and funding members of Congress. 9 out of every 10 members of the House and all but 3 members of the Senate have received campaign contributions from these lobbies. This is troubling as members of Congress are supposed to represent the people that elected them, but these facts show that many of them are in the pockets of big pharma. In fact, the pharmaceutical industry has 2 lobbyists for every member of Congress and they collectively Taylor 7spent $152 million on influencing legislation in 2016 alone.
The United States is a country of checks and balances and the Iron Triangle is supposed to be its own form of that, but there is a serious problem in the country when companies and businesses are able to directly affect legislation that only benefits them and not the rest of the country. The next part of the triangle is Congress. Congress is made up of the House of Representatives and the Senate and provides friendly legislation to the interest groups that support them while also funding and giving political support to the bureaucracy. Congress tries to make laws that are good for our country and the people in it, but since the majority of Congress members have been funded by the pharmaceutical industry, big pharma is able to get special treatment and can more easily work towards favorable legislation. Congress has the most power in the Iron Triangle, but they the most likely to abuse their power as well. The last part of the triangle is bureaucracy. In this scenario, it comes in the form of the Drug Enforcement Agency. The DEA is tasked with combating everything drug related, mainly focused towards smuggling, and are able to enforce this through laws passed by Congress.
They try to enforce laws that have been passed by Congress to make the country safer. They also work towards regulating pharmaceutical companies, and are constantly at risk of losing power from Congress due to big pharma’s monetary grasp. As of recently, big pharma has been going to war against the DEA and have used their vast wealth and their control of Congress to wage it. As stated earlier, 9 out of every 10 members of the House and all but 3 members of the Senate have received campaign contributions. Because Taylor 8of this, big pharma was able to work with Congress on The Ensuring Patient Access and Effective Drug Enforcement Act, a law that would cripple the DEA and take away the power that made them a check towards big pharma in the first place. Representative Tom Marino (R-PA) presided over the bill that was meant to weaken the aggressive DEA enforcement against companies that distributed drugs to corrupt pharmacists and doctors who sold pills on the black market. It also makes it almost impossible for the DEA to freeze narcotic shipments, which have been used as a powerful tool to help immediately prevent drugs from getting onto the street. This dangerous bill was made to help drug companies continue to help peddle drugs on the illegal market.
One shocking detail of the bill is that it flew through Congress almost unanimously, and even President Obama signed it into law without truly know the bill’s impact. This shows the extent that big pharma has over Congress in that they were able to pass a bill that limits drug enforcement during the height of the opioid crisis. Congress isn’t the only place that pharmaceutical companies have been able to buy.
Many high ranking members of the DOJ and DEA have been poached by big pharma, including Linden Barber, the top lawyer for the DEA’s Office of Diversion Control. Barber played an important role in creating an early version of the law that Congress would ultimately pass. He was also able to bring intimate knowledge of the DEA’s tactics and how it could be attacked for the benefit of pharmaceutical companies. Due to this, the DEA lost the control they had had for nearly 40 years and were forced to stand by as doctors and pharmacists filled out fraudulent prescriptions. The pharmaceutical companies along with the help of Congress were able to strip the DEA’s power. President Donald Trump has now Taylor 9currently nominated Rep.
Marino to be the nations next Drug Czar, the head of the nation’s drug policies.As problematic as this is, each part of the triangle has ways to improve and to turn the triangle back to its way of checks and balances. Congress has an obligation to the American people. They can take funds from the pharmaceutical industry but must commit to serving the people first and foremost. They must make laws and give power back to the DEA so they can enforce and regulate the pharmaceutical companies. The DEA must continue to work to guarantee the safety of American citizens. They must also hire people committed to the citizens instead of the money so that they don’t give up their tactics if poached away by pharmaceutical companies. They must also fight to keep their power so they can continue to do their jobs effectively.
Lastly, these pharmaceutical companies need to work towards fixing their product instead of lying and lobbying just to get the government to ignore it. While they are still granted the right to lobby because of Citizens United vs. the FEC, ruling that money counts as speech, they should work with the government to make their product as good as possible for everyone. Each side needs to work on their own problems, and only then can the crisis begin to be solved.