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Drug policies without compassion are doomed to fail

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A needle used for shooting heroin and other opioids litters the ground on a sidewalk in the Kensington section of Philadelphia. (Charles Mostoller/Reuters)

If you ask people what caused the opioid crisis ravaging our country, you’ll no doubt hear that doctors are to blame for handing out painkiller prescriptions too liberally. That narrative makes sense: Over the past few decades, doctors have massively increased the amount of opioid prescriptions going to patients. Most heroin users report that they started off abusing prescription drugs.

But this gets at a basic misconception of the crisis. The epidemic is not really about prescription practices — or at least, if it was, it isn’t any longer. It’s about a lack of care for people who are dependent on the drugs. Unfortunately, policymakers are learning this the hard way.

In response to the surge in opioid overdoses, lawmakers across the country have clamped down on prescription practices. Today, every state and the District have prescription drug monitoring programs, which allow law enforcement and sometimes doctors to prevent patients from “doctor shopping” from prescriber to prescriber to stock up on pills. In fact, the federal government has spent more than $100 million over the course of the past decade to help states develop these programs. Studies have shown that these programs have been successful in reducing doctor shopping, so they’re generally popular.

Problem solved, right? Well, no. Opioid prescriptions have fallen in recent years, but nonetheless overdoses continue to skyrocket. In fact, a new study published in the Annals of Internal Medicine — which reviewed 17 studies about the effectiveness of prescription drug monitoring programs — shows that there is no strong evidence that such programs have worked to reduce opioid deaths.

Worse, this review also found that the drug-monitoring programs might have a troubling unintended consequence: a substitution effect. The fewer prescription drugs that abusers can get their hands on, the more likely they are to turn to more dangerous drugs. Three studies included in the review found that heroin overdose deaths increased after drug-monitoring programs were implemented.

This news is bound to frustrate people. Prescription drug monitoring is one of the few policies that both the Obama and Trump administrations touted as a potential solution to the crisis. But despite all the work done so far, the programs have come up short.


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