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Trump Anti-Opioid Commission Overlooks Prevention, Favors Supply Cuts

a graph showing "prevalence of problem behaviors at age 19-21" on the vertical axis with 10% ranges from 0-70% and "drug abuse" and "smoking" statistics for groups of all females, all males, and males dristuptive in first grade on the horizontal axis. the males disruptive in the first grade had clearly the highest problem prevalence

First and foremost, this article is politically neutral. We are not here to oppose President Donald Trump, and we are not here to support him. America has become quite a divided nation in this regard. We are simply here to report on the latest report from the President’s Commission on Combating Drug Addiction and the Opioid Crisis, and then to give some opinions from there. We will say that Trump’s commission has quite a long name, so from now on it will be referred to as the CCC, which we’ll say is short for ‘the commission combating the crisis.’ The CCC’s latest report was issued this October, and it heavily favors limiting and/or cutting-off opioid supply over reducing and/or eliminating demand for illegal opioid use. In other words, the CCC is extremely focused on both the criminal side of opioids and the way legal opioid prescriptions are handled. They are focused loosely at best on the prevention side of the fight against the opioid epidemic. This article explains why this is true, why this could be bad, and what could change if prevention were weighed evenly with cutting off supply.

Limiting Supply is a Good Thing, But…

Yes it is. Trump and his commission’s focus on criminal drug-dealing operations is extremely important business. There are plenty of high-scale dealers willing to do just about anything for another dollar. This includes violence, spiking drugs with deadly substances, and selling to anyone with cash – regardless of his or her condition. However, criminalizing regular people who happen to be opioid addicts has proven to be devastating. We all know how absurd some of the jail sentences are for non-violent drug offenders. So, does all of American law enforcement believe that addicts are diseased, not criminals? We think you know the answer here… The CCC’s focus on prescriptions is also extremely important business, perhaps more so than the black market. After all, the vast majority of heroin addicts began with legal opioid pills such as Vicodin or OxyContin. It’s difficult to pinpoint who exactly is to blame for it, but this country is FLOODED with opioid pills. There are enough prescriptions for them written every year to give every single adult American his or her own bottle. Over-prescribing opioids is a terrible thing, and changes need to be made. However, just as with fighting the criminals, restructuring the legal side of opioids still doesn’t prevent people from abusing drugs.

The Commission’s Report

The full text of the report can be found here. The report in total makes 56 recommendations for how to combat the opioid crisis. Two of them are focused on prevention, and one of those two recommendations is for an ad campaign. Advertisements are old news. We live in a world now where we fast forward through them all, because we’ve recorded the program we actually want to see. Sorry, CCC, but ad campaigns simply don’t work. The commission’s other prevention-based recommendation is called SBIRT. It’s short for ‘screening, brief intervention, referral to treatment,’ and frankly it’s an awesome program. However, it does not prevent people from starting abuse – it (attempts to) identify people already abusing and prevent further abuse. The commission did not invent SBIRT. It began with a theory presented by the Institute of Medicine, and is now endorsed by SAMHSA, the Substance Abuse and Mental Health Services Administration. SBIRT actually consists of three separate components: the screening, the intervention, and the referral to treatment. Here’s how it works. Say you have a regular old doctor visit. You’re just getting a physical examination and hoping your cholesterol levels are normal. If the office you’re visiting participates in SBIRT, (which many do nowadays), part of your visit will include a screening for possible drug abuse. Your doctor will assess you and determine using standard screening methods if you are abusing substances. No, it’s not foolproof, but it is evidence-based. Next comes the ‘BI’ part of SBIRT, the brief intervention. According to the SAMHSA website, during this part of the process, “a healthcare professional engages a patient showing risky substance use behaviors in a short conversation, providing feedback and advice.” If your screening shows you to be negative for substance abuse, there will not be an intervention. Finally comes, the ‘RT’ part, the referral to treatment. Again according to SAMHSA, “a healthcare professional provides a referral to brief therapy or additional treatment to patients who screen in need of additional services.” Does it work? Keith Humphreys is a government adviser in the field of drug prevention and treatment. He also happens to teach at the Stanford University School of Medicine. He also happens to think that SBIRT isn’t as effective as it should be. Humphreys was quoted as having said this recently to the New York Times: “The brief intervention part of S.B.I.R.T. has had success at changing problem drinking, but little with drug use. Referral to treatment has been a failure across the board. Almost no one follows up.” Also, SBIRT does not prevent people from getting into drugs.

Preventive Methods to Combat the Epidemic

The remaining 54 recommendations made by the CCC involve in some way or another cutting off the supply of opioids to America. Obviously we are much more prepared to get rid of the drugs than we are to get rid of the addictions. This could be bad. It’s this writer’s humble opinion that we will never be able to fully get rid of drugs. They will always exist, no matter how many pounds of them are seized. It’s like that arcade game Whack-a-Mole; every time we knock one down, another will pop up. If you prevent people from getting into drugs in the first place, it essentially doesn’t matter how many drugs are around. This is not to say we shouldn’t try and limit the supply of opioids. This is to say we should also be preventing the desire to abuse opioids altogether. Trump’s commission mentioned two methods of prevention in their report last month. However, there is an entire world of preventive methods out there to combat the opioid epidemic. Let’s discuss a few of them. We think you, dear reader, will start to see just how important preventing drug abuse truly is.

The Nurse Family Partnership

Sometimes effective drug abuse prevention comes in a form you wouldn’t quite expect. The Nurse Family Partnership, or NFP, is a non-profit organization which places registered nurses in homes of first-time mothers who have low income. The nurses are there to educate the mothers about pregnancy and motherhood, help develop parenting skills, and promote infant health. It’s a beautiful program. What does it have to do with drug abuse prevention? Well, in the results section of a fifteen-year long 1998 study published in the Journal of the American Medical Association all about the long-term effects of nurse home visitation, there is this sentence: “Parents of nurse-visited children reported that their children had fewer behavioral problems related to use of alcohol and other drugs.” More up to date, a similar study, but twelve years long, was published in 2010 in Pediatrics and Adolescent Magazine that claimed, “By the time the firstborn child was 12 years of age, those visited by nurses, compared with those in the control group, reported fewer days of having used cigarettes, alcohol, and marijuana during the 30-day period before the 12-year interview…”

The Good Behavior Game

Back in 1967, Muriel Sanders just began her new job as a fourth grade schoolteacher. In order to maintain good behavior in her classroom, she developed a kind of game. Students were given a point for each occurrence of bad behavior, and then whoever had the fewest points would win a prize. Two years later, Sanders, Harriet Barrish, and Montrose Wolfe (who invented the ‘time-out’ for kids), officially created the Good Behavior Game. The game is still being used in classrooms. In fact, in 2010, NIDA, (the National Institute on Drug Abuse), published a paper with the title Behavior Game Played in Primary Grades Reduces Later Drug-Related Problems. The opening line of the paper: “Awarding smiley-face stickers to teams of first-graders in Baltimore for the good behavior of the individual team members greatly increased the likelihood that the students would experience an adolescence free of substance abuse and dependence.” The Good Behavior Game doesn’t just work – it works quite well. From the NIDA paper as well comes this eye-opening graphic: trump anti opioid commission

Communities That Care

The final program we will mention began at the University of Washington and is now national. Communities That Care, or CTC, creates support groups within communities nationwide that foster good decision making and try to utilize evidence-based methods to stop and/or prevent drug abuse. It works well too. A trial involving 4,407 students was conducted, and followed them for three years starting in fifth grade. There was a control group not given the CTC program, and a group that was given the CTC program. According to their website, “Panel students from CTC communities were 25% less likely to have initiated delinquent behavior, 32% less likely to have initiated the use of alcohol and 33% less likely to have initiated cigarette use than control community youths.” These numbers are staggering.

In Conclusion

It should be known that Trump’s CCC report from last month does mention these programs, and more, but it does not actually recommend implementing them. One can guess that means governmental funding for them will not be supplied. This doesn’t mean they’ll disappear, but they could be used on a much grander scale. This writer, for one, remembers the D.A.R.E. program and how inefficient it was. Perhaps things like the Good Behavior Game and Communities That Care should be implemented. Strangely, no specific funding amounts were given in the report at all. For this reason, the report was met with some disdain. For example, Chuck Ingoglia, senior vice president of the National Council for Behavioral Health, said the CCC’s report “starves the country for the real resources it needs to save American lives.” On the bright side, the report recommends a one-application process for states to receive multiple federal grants, which is a world easier than the current process of applying for each and every grant individually. New Jersey Governor Chris Christie is head of the commission. He knows personally how tragic drug abuse can be, having lost more than one person close to him to drugs. Although nobody knows how much money will actually be spent to implement some of the report’s suggestions, Gov. Christie did say in late October on cable news program This Week that Trump would soon be asking for an increase in funding for the good fight. Richard Frank, former Obama administration member and Harvard Medical School professor, believes that it would cost approximately $10 billion annually “to provide medication and counseling to everyone with opioid use disorder who is not already in treatment.” Considering how many billions of dollars are tossed around daily, this seems well worth the cost.

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