Spending Money on the Opioid Crisis

Today's Seacoast Sunday headlines a study done of the outcomes of government spending to try to stem the "opioid crisis."
It was a story produced by the Granite State News Collaborative, which meant it provided actual researched news--a rarity for our local "newspaper."

What it showed was that the "opioid crisis" is not a single problem but a web of problems.  
1/ The problem of death from acute opioid overdose.  For the past two years there have been about 470 overdose deaths in New Hampshire annually and as of October this year we stood at 312. This may mean we'll do slightly better this year, and that has been attributed to the wider availability of Narcan on EMT trucks.

Of course, as many of the EMT folks have observed, the same addict tends to be rescued three or four times in a week, and these front line folks ask what is the purpose of rushing out to save a person who is determined to repeat the same behavior, until they do it in a place nobody notices.

2/ The problem of ongoing addiction: While the number of ambulance runs can be counted and recorded easily enough, the number of opioid users is a more difficult thing to quantify because people tend to not raise their hands when asked who is engaging in illegal behavior. 

3/ The problem of assessing efficacy of intervention: for which there is a well established set of techniques, from the scientific point of view, but there is incentive for both government and the "vendors" they pay to claim success where there may be none, like the old "body count" data from Vietnam, which always showed we were winning that war.

Programs to treat addicts basically come down to replacing one addiction--heroin/Fentanyl with another, to methadone or suboxone which are drugs which allow patients to return to normal work and life activities. This is called "medication assisted therapy" or MAT, because calling it "replacement addiction" would not, presumably, be welcomed by the governor or the legislators. 

The National Institute of Drug Abuse posts this on its website:

According to several conservative estimates, every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1. Major savings to the individual and to society also stem from fewer interpersonal conflicts; greater workplace productivity; and fewer drug-related accidents, including overdoses and deaths.

But consider the source:  Would you expect employees of the NIDA to post a statement that says: "Oh, nothing we are doing is helping much" ?


There are about 300 clients for these MAT programs in Littleton, NH, but no figure is give for the state, oddly enough. Given the 24/7 nature of the programs, and the number of hospitals and EMT services which are involved, although most of these not full time, it is entirely possible that more people are, if not making a living, at least profiting from the opioid crisis than are actually being saved by the response.

Last year, at a Rockingham County Democrats meeting, Mad Dog asked Tom Sherman, MD , the New Hampshire state senator,  what evidence he had that the money spent was actually doing anything important to address the problems of drug deaths or drug addiction. At first he said there were statistics to support the benefit but when pressed, he finally admitted he could not bring any to hand and he asked, "But what's the alternative? Just giving up on these people?"

Bubbles 

Of course, there were parents of people who had died from opioid drug overdoses int he audience and they stared hate across the room at Mad Dog, but undeterred, Mad Dog alluded to the graph from the National Institute of Health Institute for Drug Abuse which showed, very clearly, that as long as drug addicts remained in their treatment programs they were apt to stop using drugs, but as soon as they left the programs, they became recidivists. 

This is true for alcoholics, of course and for that matter, for diabetics and hypertension.  The graphs shown above are from the NIDA website and the point is, of course, that as long as the patients remain in treatment, they do well, but as soon as they leave the treatment programs, they relapse, in the case of addicts, to the use of opioids. 

But the question is: Are we prepared to spend as much money on programs for addicts as we are on ongoing therapy for diabetes and hypertension?

You knew it was coming, but Mad Dog simply must refer you to the best single exploration of drug culture ever done: the TV series "The Wire."  Most people simply cannot endure the reality of this fictionalized show and stop watching. But that's the rub: If we, as citizens, are unwilling to actually face reality, but would rather throw money at it like some street beggar just to make it go away, we will never make progress in solving the problem we refuse to actually face.