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Presidential Candidates Barely Acknowledge the Opioid Crackdown's Threat to Pain Patients

March 2, 2020
Here’s what the remaining 2020 candidates think about opioids, addiction, and pain.

During last October’s Democratic presidential debate in Ohio, billionaire hedge fund manager and then-candidate Tom Steyer erroneously claimed that “72,000 people died of opioid overdoses last year.” The actual number in 2018, according to the CDC was 46,802. Steyer’s exaggeration was especially misleading because the context was a discussion of legally produced pain medication, which was reported in just 12,552 of those cases (excluding methadone), or 27% of opioid-related deaths.

By contrast, the category of opioids that includes illicit fentanyl and its analogs was involved in 67% of opioid-related deaths that year, while heroin was reported 32% of the time. Overall, CDC records indicate, heroin and/or fentanyl figured in 80% of opioid-related deaths in 2018, including more than two-fifths of the deaths involving “natural and semi-synthetic opioids,” the category that includes commonly prescribed analgesics such as hydrocodone and oxycodone.

The remaining major-party presidential candidates seem to have shown little or no concern for the patients who suffer from indiscriminate attempts to reduce their pain medications.

Although the vast majority of opioid-related deaths involve illegal drugs, the discussion that night focused on pain pills. Senator Amy Klobuchar (D–Minn) said companies that manufacture prescription analgesics should pick up the tab for treating opioid use disorder. Steyer said the problem is “drug companies buying the government and getting what they want.” Other candidates have stated that the executives of those companies should go to prison for their role in fostering opioid addiction—an idea endorsed by former Vice President Joe Biden during the February 7, 2020, Democratic debate in New Hampshire.

As those comments reflect, the major-party candidates for president seem to be united in blaming the increase in opioid-related fatalities over the past two decades on the over-prescribing of pain medication, which they say was encouraged by greedy pharmaceutical companies that pursued profit without regard to public health. By contrast, only a couple of the candidates acknowledge the downside of policies based on that premise—in particular, the threat to bona fide patients posed by ham-handed efforts to curtail opioid prescriptions.

Here is a summary of the relevant positions staked out by the remaining major-party candidates - as of March 8, 2020.

 

Joe Biden
“The greed of drug companies fueled an opioid epidemic that has ravaged communities in every corner of the country,” the former vice president tweeted last August. “They should be held accountable for their actions.”

Biden promises on his healthcare webpage to “tackle” opioid addiction but has not unveiled a plan yet. The only reference to pain treatment on his campaign website overall, however appears in a discussion of healthcare for veterans: “The VA must continually strive to improve services and outcomes for veterans, especially in the areas of pain, polytrauma recovery, substance use disorder (SUD), post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and general behavioral health, in the most effective and cost-efficient way possible.”

Elizabeth Warren (Warren has left the campaign since this was first published.)
The Massachusetts senator touts her sponsorship of the Comprehensive Addiction Resources Emergency (CARE) Act, which would authorize additional federal funding for addiction treatment if approved. The bill seeks to promote “prescribing best practices” and “alternative pain therapies,” including “non-opioid pain management” and “non-drug pain management.”

At the same time, Warren acknowledges the continuing need for opioids to treat chronic pain. “It’s essential that we work to ensure that programs and policies meant to deter abuse do not unintentionally force millions of Americans to lose access to critical medicine and live in pain, and my administration will take care to balance these needs,” she writes on her campaign website. “Further, we will also work to increase access to alternative pain management treatments by legalizing marijuana and ensuring other substances are appropriately scheduled by the Drug Enforcement Administration.”

Bernie Sanders
The Vermont senator, a co-sponsor of Warren’s CARE Act, likewise promises to “ensure that the nearly 1 in 6 Americans with chronic pain and the nearly 20 million with life-altering pain have access to pain management and treatment, including, where appropriate, access to pain medication.” Outlined on his website, his position on disability rights further states, “We will work actively to ensure that policies designed to curb opioid use in general do not result in people with disabilities who rely on opioids for chronic pain losing access to them, or being abruptly or forcibly tapered or abandoned in care altogether. We will also cover evidence-based alternatives for pain care, and invest in pain research and the education of clinicians about pain treatment.”

Tulsi Gabbard
In a speech last October, the Hawaii congresswoman complained that “big pharma companies, like Purdue Pharma, who cheated and lied to the American people to proliferate their highly addictive opioids on our streets, ruining people’s lives and causing the deaths of tens of thousands of people, walk away with barely a slap on the wrist.” Gabbard last year introduced the Opioid Crisis Accountability Act, which would threaten employees of pharmaceutical companies with hefty fines and up to 10 years in prison for “dubious marketing or distribution practice[s] with respect to an opioid.” Her campaign website mentions cannabis, but not opioids, as a treatment for chronic pain.

Donald Trump
In 2018, the Trump administration unveiled a “Safer Prescribing Plan” that aimed to “cut nationwide opioid prescription fills by one-third within three years.” The White House has bragged that “high-dose opioid prescriptions fell by 16% since President Trump took office.” It does not mention, however, that the upward trend in opioid-related deaths accelerated as the government succeeded in driving down opioid prescriptions, largely because nonmedical users switched to black-market substitutes that are far more dangerous because their potency is highly variable and unpredictable.

Secretary of Veterans Affairs Robert Wilkie has cited his department’s efforts to reduce opioid prescriptions for veterans as a model for the rest of the country. “VA has taken a multi-faceted approach called the Opioid Safety Initiative to reduce the need for opioids,” he wrote in 2018. “Since its launch, the program managed a 45% reduction in veteran patients receiving opioids from July 2012 to June 2018.” Wilkie did not mention evidence that “opioid discontinuation” under the initiative “was associated with increased suicide mortality.”

Both the CDC and the FDA have acknowledged that the drive to reduce opioid prescriptions has hurt people suffering from chronic pain, noting that doctors have responded to the CDC’s guidelines by forcibly and abruptly tapering patients or cutting off treatment altogether. But President Trump’s campaign website, while touting his efforts to reduce opioid prescriptions, says nothing about ensuring adequate pain treatment.

Overall, with the notable exceptions of Warren and Sanders, the major-party presidential candidates have shown little or no concern for the pain patients who suffer from indiscriminate attempts to reduce prescriptions of opioid analgesics. As in the general public debate about this issue, that concern so far has received barely any lip service, let alone serious attention.

Positions from the Most Recent Candidates in the Running

Former New York City mayor Michael Bloomberg dropped out of the running on March 4, 2020. In his “Seven Step Plan for Ending the Opioid Crisis,” he argued that the federal government and the states have not gone far enough in discouraging opioid prescriptions, noting:

We must stop doctors from over-prescribing opioids, especially when non-addictive pain medications (such as ibuprofen or acetaminophen) would be just as effective. Steps have been taken to educate doctors and to curtail prescriptions for opioids (such as Oxycontin, Percocet and Vicodin), and the prescription rate has fallen from its peak in 2010. But it remains three times what it was in 1999 — and four times what it is in Europe.

More aggressive action is needed. The Food and Drug Administration should allow only doctors who complete specialized education in pain management to prescribe opioids for more than a few days….Some states have limited the size of certain opioid prescriptions—all should do so. To avoid the need for bans or other draconian measures, which would harm people suffering the most severe chronic pain (including many who are terminally ill), the medical profession must do more to rein in prescriptions and create effective monitoring programs.

 

Former mayor of South Bend, Indiana, Pete Buttigieg removed himself from the presidential race on March 1, 2020, but he had supported the decriminalization of possession of drugs, including opioids. Pain treatment was mentioned just once on his campaign website, in the context of racial disparities in healthcare

Amy Klobuchar, the Minnesota senator who dropped out on March 2, 2020, had posited wanting to raise money for addiction treatment by taxing pain medication, warning that “opioid addiction can begin with the use of appropriately prescribed pain medications.” She is the chief Senate sponsor of a bill that would require physicians and pharmacists to consult prescription drug monitoring databases before writing or filling prescriptions. Klobuchar had promised a “major investment into research and development of pain [treatment] alternatives to opioids” and “a national effort to create additional safe and responsible ways to dispose of unused prescription medications.”

 

Jacob Sullum is a senior editor at Reason magazine and a nationally syndicated columnist. He previously reported on the conflict between opioid control and pain control for PPM.

All cited websites were accessed in February 2020.    

           

 

 

 

Last updated on: March 12, 2020
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The Intensifying Conflict Between Opioid Control and Pain Control
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