In 2013, my father received one of 13.6 million prescriptions for Opiates written for Floridians. The orange pill bottle remained untouched on our kitchen counter for three weeks before he threw it away, along with papers for two refills. Though he experienced lots of pain post life-threatening surgery, he feared something far worse: The risk of addiction.
My father was more fortunate than the 2,798 Floridians who passed away in 2016 due to opioid-related overdose. Between 2014 and 2015, the death rate due to opioid overdoses in the country increased by 16.3 percent. The rate in Florida increased by nearly double: 31 percent, Health publication STAT forecasts the national death toll over the next ten years under ten distinct scenarios, the average predicting a total ten-year death toll of 500,000 people - about the population of the City of Miami.
The Trump administration is divided on how to approach the issue. Health secretary Alex Azar and FDA commissioner Scott Gottlieb call for “greatly expanded access to opioid based addiction treatments like methadone,” while President Donald Trump expressed preference of a death penalty:
“Some countries have a very tough penalty, the ultimate penalty, and they have much less of a drug problem than we do,” Trump said. By contrast, Azar calls for an increase in the use of Medication-Assisted Treatment (MAT). MAT, in short, is a combination of cognitive therapy (counseling) and rehabilitative medication.
Florida’s response will take effect in July. HB-21 will “limit opioid prescriptions for acute pain to a three-day supply, and, when deemed medically necessary, a seven-day supply.” Attempting to limit the flow of opiates to consumers is a step in the right direction, but some doctors fear the intervention is too intense, and patients can’t afford the time or money to refill prescriptions every three days. Tallahassee Orthopedic Surgeon Dr. Hank Hutchinson expressed to the Orlando Sentinel, “Putting a strict day limit on prescripts is really bad for our patients. You’re going to cost them a lot of money by having to get refills all the time.”
The bill also mandates use of a Prescription Drug Monitoring Program, or PDMP. This is a statewide database where both doctors and pharmacists input prescriptions given and filled for each individual. Florida’s PDMP, called E-FORSCE, was established in 2011 but not made mandatory to use until HB-21’s effect on July 1 of this year. This is the best action that the state has taken regarding the issue. Given an efficient implementation, A mandatory reporting system eliminates the problem of adverse selection, where individuals can travel to different pain clinics to get opiates from different sources.
The opiate epidemic is a rapidly growing problem that must be addressed from a health perspective. President Trump treats it as a crime problem, threatening an increased use of the death penalty to punish drug traffickers. Some other government officials prefer the use of medication combined with therapy, combined with legislation already passed that would attempt to monitor the flow of legal opioids. This type of government program is expensive - but compared to the $1 trillion that the opioid epidemic has cost the country since 2001, no check seems too big to cut - if spent wisely.