A law of unexpected consequences

In a makeshift courtroom at Touro College, the roots of the current opioid epidemic are being dissected in the first case of its kind in the nation to go before a jury. Three manufacturers and a drug distributor continue to argue that the wave of addiction and deaths darkening the Island for a decade is not due to their aggressive marketing and sale of prescription pain pills.

The fact that several co-defendants have settled with the state, bringing a total of about $200 million to Nassau and Suffolk counties, isn’t strengthening their case.

But four years before that suit was filed, New York adopted the Internet System for Tracking Over Prescribing, ISTOP, to stem the carnage. The drug companies had convinced the FDA, doctors and pharmacists that newly developed opioids offered little risk of addiction to patients in pain, and could be safely and generously prescribed.

It wasn’t true, and the permissive environment had devastating effects. Many patients, unaware of the dangers or vulnerable because of prior addiction issues, got hooked, and began seeking prescriptions from multiple doctors and pharmacies. Many doctors overprescribed out of a sincere desire to help. Other doctors got hooked on the quick money they could make writing painkiller prescriptions for cash and authorized millions of deadly doses.

And the black market was soon flooded with cheap prescription opioids.

ISTOP, which demanded patients, doctors and pharmacies be monitored online in real time to stop doctor shopping, pill mills and other abuses, was one answer.

The law worked as designed, helping stem the tide of new addictions.

But it also had unexpected consequences. Some who died of overdoses of heroin and fentanyl post-ISTOP would likely be alive if the supply of pills had not been cut so dramatically, pushing addicts to street opioids.

Overdose deaths are accidents, happening when users unwittingly ingest too much. Prescription painkillers are, for all their ills, predictable. A certain dose of oxycontin has a certain effect, and regular users know what to expect.

But users buying heroin can’t know what they’re getting. Fentanyl, cheap and strong and deadly, became the go-to ingredient for dealers cutting heroin, and a skyrocketing cause of death. And thousands of Long Islanders died.

The issue is the law of unintended consequences, not blame. ISTOP was well-intentioned and effective, but addiction is a bear.

It’s accepted wisdom, and true, that substance-abuse prevention must be prioritized because addiction treatment is so frequently unsuccessful. Convincing people to run from the deadliest intoxicants, and to be highly wary of the milder, legal ones, is key.

But addiction prevention also must become something deeper.

We need to talk about why so many people, and often very young people, are in so much emotional pain that they cannot bear to be sober. Seeing the deadly overdose numbers spiral during the pandemic after they’d declined reminds us how closely substance abuse is tied to pain.

Nurturing love can help prevent addiction. So can a sense of belonging, a feeling of purpose, devotion to a higher cause. Trustworthy spiritual institutions can grant solace otherwise sought in a needle or pipe. So can mentors.

Our society itself is increasingly ill: shallow and selfish and self-aggrandizing and angry, disconnected and materialistic and cruel. That’s a painful way to live.

And addressing that is probably the only way of taking on addiction that won’t come with unexpected and negative consequences.

Columnist Lane Filler's opinions are his own.

By Lane Filler

lane.filler@newsday.comlanefiller

Lane Filler is a member of the Newsday editorial board.