Opioid Epidemic Supply Side

Purpose
The purpose of this executive summary is to provide an overview of the issue of the opioid epidemic in the U.S. and how supply-side factors have played a role in the spread of this epidemic. According to Pacula and Powell (2018) in the Journal of Policy Analysis and Management, published at Rand.org, the opioid crisis “is a complex, multifaceted, and dynamic problem requiring a comprehensive strategy for dealing not just with the stock of addicted users who are at risk of overdosing, but also considering the flow of new initiates and escalators in abuse.” This summary will discuss the background of the issue, the results of the research by Pacula and Powell (2018), available federal data, appropriate economic predictors, and three reliable and implementable recommendations.
Background
The opioid epidemic has ravaged the U.S. in recent years. The U.S. Department of Health and Human Services shows that 2016 alone, 116 people died every day from opioid-related overdoses (HHS, 2018). The problem stems from the rise of the pharmaceutical industry and its development, manufacturing and sale of prescription drugs that were highly addictive and so very effective in relieving the pain of individuals that for addicts they became a way of obtaining a “high” that then became something to be desired in and of itself. This “high” has been an allure for many millions of people who use prescription drugs illegally and/or abuse their own prescriptions in order to achieve a “high” from the drugs. The result has been a tremendous loss of life, a problem of crime, a problem of family deterioration, and a problem of economic trouble as more and more people are becoming addicted to opioids and not entering into the workforce to support their families, communities and the overall national economy (Blackstone, Fuhr & Pociask, 2014).
Results of the Research
The key findings of the study by Pacula and Powell (2018) are that supply-side factors contributed significantly to the rise of the opioid crisis. This means that the pharmaceutical companies bear considerable responsibility in this problem as they were the ones manufacturing highly-addictive drugs and selling them at very cheap rates so that the market was oversaturated with them and they became readily available to the public. The federal government also played a role in this rise as it subsidized health care that included prescription drug treatment and thus incentivized physicians to overprescribe in some cases. Pacula and Powell (2018) identify the following results in their study:
· Opioids were promoted by manufacturers to medical professionals, medical and hospital boards, and patients, sometimes with misleading evidence of their addictiveness or effectiveness.
· Declining drug prices lowered the cost of prescription opioids since 1999, which led to increased utilization.
· Health care reimbursement rewards volume of services, creating an incentive for providers to overprescribe (Pacula & Powell, 2018)
Another finding of the study is that while since 2010, deaths from prescription opioids have declined, deaths of illicit opioids like heroin and fentanyl have increased dramatically in the words of the researchers.
The models used to obtain the results include examining the supply-side factors of the opioid issue and examining the relevant published data and statistics available at the national level to develop an understanding both of the scope of the problem and the ways that it can be effectively addressed. The researchers identified three main challenges to the opioid crisis:
· New users of illicit street drugs tend to be unsophisticated and thus at elevated risk of overdosing.
· Consumers of street drugs can be exposed to "cutting agents"—additives designed to stretch the supply of opioids—that can heighten the danger of using the drug.
· Illicit opioids are more likely than prescriptions to be injected, creating the risk of exposure to costly and fatal infectious diseases, such as Hepatitis C and HIV (Pacula & Powell, 2018)
This means that the individuals who are not only selling the drugs on the streets but also using them are not aware of the pharmacological impact of these substances or how to regulate them safely. They can quickly use and abuse them and cause many problems for the community.
Economic Indicators
In 2017, the Council of Economic Advisors estimated that the cost of fatalities due to the opioid crisis stood at $431.7 billion. Moreover the council reported that “prescription opioid misuse increases healthcare and substance abuse treatment costs by $29.4 billion, increases criminal justice costs by $7.8 billion, and reduces productivity among those who do not die of overdose by $20.8 billion (in 2015 $). The total nonfatal cost of $58.0 billion divided by the 1.9 million individuals with a prescription opioid disorder in 2013 results in an average cost of approximately $30,000” (p. 7). These costs place a substantial drag on the economy, and cause health care prices to soar while working class persons face higher premiums and deductibles in the face of all this rising cost.
The economic indicators of this crisis worsening are the lessening of drug costs as these opioids hit the streets in increasing amounts and the rising costs within the justice system as the law enforcement agencies must work to address this crisis. There is also a substantial loss of productivity among prime working age individuals because they are becoming addicted to opioids and not contributing to the workforce in a meaningful way as a result.
Recommendations
First Recommendation
The federal government must double down on reducing the supply of opioids on the black market. This can be achieved through focused attention by law enforcement agents on eliminating drug dealers from supplying the streets with illicit opioid products and by prosecuting those who allow opioids to reach the black market from lawful trade arenas.
As the increase in opioid use has risen most since 2010 in the black market, this must be the focus of law enforcement today and should receive more support from federal agencies as law enforcement attempts to reduce this supply. Another issue to be addressed on this front is the flow of heroin from the Middle East and how better initiatives can be taken to stop this traffic.
Second Recommendation
The second recommendation is for punishment to those who are addicted to these substances to be reduced as this is a mental health problem that has been recognized by researchers (Blackstone et al., 2014). It should not be treated as a crime by addicts for abusing these drugs but rather as an issue that requires counseling and addiction support. By helping these persons to overcome their addiction, further reduction in the spread of the opioid crisis can be achieved.
Third Recommendation
High quality treatment should be provided individuals who are addicted to opioids, “including medication-assisted therapies (MAT)” which are available and should be used by the justice system when addressing individuals who are arrested for drug abuse (Pacula & Powell, 2018). MAT is controversial among prosecutors but it is advocated by mental health experts who cite the increase rate of successful breaking of the addiction as a result of MAT versus quitting cold turkey.
Conclusion
The opioid crisis is an epidemic in the U.S. and Pacula and Powell (2018) have shown that the supply-side factors in the rise of the opioid crisis are considerable. With the pharmaceutical industry manufacturing cheap drugs and health care providers incentivized by the government to overprescribe, these opioids have flooded the streets and led to a rise in addictions. Illicit opioids are also now more available all over the black market and the economic impact of this crisis is very high at roughly half a trillion USD currently. To counter this crisis, it is recommended that the supply side be reduced, that addicts be treated as mental health patients rather than as criminals, and that high quality treatment, including MAT, be provided.
References
Blackstone, E. A., Fuhr Jr, J. P., & Pociask, S. (2014). The health and economic effects
of counterfeit drugs. American Health & Drug Benefits, 7(4), 216.
Council of Economic Advisors. (2017). The underestimated cost of the opioid crisis.
Retrieved from https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf
HHS. (2018). About the U.S. opioid epidemic. Retrieved from
https://www.hhs.gov/opioids/about-the-epidemic/
Pacula, R. & Powell, D. (2018). A supply-side perspective on the opioid crisis.
Retrieved from https://www.rand.org/pubs/external_publications/EP67511.html