While over-burdened treatment centers struggle with ever-rising rates of addiction and overdose, more than 100 cities and states have joined the parade of litigation started by Chicago in 2014. Citizens have good reason for outrage, but if anyone thinks these lawsuits will solve our opioid crisis, they will be highly disappointed.
And considering the current number of Americans who die of opioids annually is equal to the population of Portland, Maine, the stakes have never been higher.
These lawsuits rightly cite unlawful marketing practices, oversupply and failure to warn patients of the high risk of addiction. Yet, as the number of filed legal grievances ticks higher, it’s clear that however well-intended or warranted, litigation is not a substitute for the hard work needed in fighting this crisis — most of which is receiving scant attention and suffering from even less funding.
The growing abuse of heroin and fentanyl — beyond pharmaceutical opioid painkillers — are a clear indication of the complexity of the problem. A change in marketing practice by pharmaceutical companies is not enough to fix the problem when only one in four opioid prescriptions is actually taken by the person to whom it was prescribed.
A limit on the number of pills being shipped to a small town will only drive addicts to readily available, cheaper and even more dangerous options like black-tar heroin. These lawsuits may provide funding for long-term solutions, but they are only a small part of what must be a comprehensive and nuanced response to this very immediate crisis.
A truly responsive approach requires that we find a way to create access to real data that tracks prescriptions and key metrics on substance-use disorder and that we close gaps in health care that we know can lead to relapses. It would mean funding and radically expanding research into the effectiveness of treatment programs. And it would be supported by collaborative partnerships between higher education, lawmakers, health systems and federal agencies.
There are clear first steps to take. In spite of the evident need, we have yet to create a federal database tracking the purchase and subscription of opioids. For more than a decade, we’ve tracked every purchase of pseudoephedrine that exceeded 9mg, but do not do the same for highly addictive and potentially deadly opioids.
State-level data are also painfully inadequate. Health systems and state agencies lack solid data about the rate and geographic distribution of substance-use disorder. That’s why an effort by Indiana University to build a first-of-its-kind data commons are so critical — both in Indiana and as a model for other states.
From what limited data we already have, we know that access to health care and health coverage is essential to ensuring the continuity of treatment programs. We see this quite clearly in prisons, which have faced a surge in the number of opioid-addicted inmates. Breaks or changes in treatment programs while incarcerated put addicted offenders at much higher risk of relapse when they are released.
While states and counties are required to provide health care to inmates, those treatments are often inferior and differ widely from what is available outside the correctional system. Even more troubling, patients often go without treatment at the very moment of their release from prison due to a gap in Medicaid coverage. Not only is this poor public health policy, but it threatens to squander any investments made by states in rehabilitating inmates.
But to accomplish any of these efforts — and countless more — we need civic institutions that actually work. We need lawmakers who are committed to a data-based approach. We need health care providers at the table to consider their role in delivering treatment and providing access. And we need well-funded research to inform both policy and treatment.
Robin Newhouse is the dean of the School of Nursing at Indiana University and the lead investigator on the Indiana University “Responding to the Addictions Crisis” initiative.