By Angela Vullo
Oct. 20, 2107-On Wednesday October 11, the U.S. House Committee on Energy and Commerce, Subcommittee on Health, held a marathon hearing at the Rayburn Building on the nation’s opioid crisis. The hearing was open to members of the committee and others to present 3 minute testimonies on the drug conditions in their districts. For three and half hours, stories, statistics, and a myriad of bills and solutions poured forward to address this historic crisis.
The states represented centered on New England and the Ohio Valley, but not exclusively. What was agreed upon is that this crisis is out of control and something must be done. Many disputed which state was the worst, with New Hampshire, Ohio, and West Virginia leading the charge, but many others not far behind. Although most testimonies focused on opioids and prescription painkillers, street drugs like heroin and the synthetic fentanyl were frequently mentioned. There was no question that this crisis has “hit home,” and many of the presenters were very passionate about their districts being destroyed by this escalating epidemic.
But virtually no one wanted to mention the elephant in the room-the economy. Congressman Steve Stivers (OH) came the closest when he said, “Before I go into the medical aspect of the crisis, I will say that “until we bring back hope and economic opportunity, this problem will not be solved.” Before we can address the economic aspect of this crisis, detailed in my October 6 article “Opioids Can’t Kill the Pain of 40 Years of Post-Industrial Economy” , further disclosure of the crisis is critical.
Coincidentally, the same week as the Congressional hearings, Progressive State Legislators, The Six, held their yearly meeting in DC. In attending the conference, we found a similar situation as on Capitol Hill, as legislators conveyed passionate stories about their state’s crisis, and argued over whose state was in the lead for overdose deaths.
“Personal, Painful, and Petrifying” Testimony
Although official CDC figures have been reported, there appears to be a discrepancy in numbers. Most members of Congress who testified on Oct. 11 cited that there are 90-91 deaths per day. This is half the amount cited by Dana Milbank in his Oct. 11Washington Post column.
Rep. Stivers reported that in 2016, 4,050 died in Ohio of unintentional overdoses. This was 32.8% increase from 2015 (3,050). Rep. Keith Rothfus (PA) reported 4,342 deaths in 2016 in Pennsylvania. Rep. Tom O’Halleran (AZ), a former police officer, reported that at least two Arizonans die every day from opioid overdoses. Last year deaths rose 16% over the year before. “Worse than what I witnessed as a cop,” he said. He added that, according to the CDC, the worst opioid abuse is occurring among American Indians and Alaskan Natives.
Rep. Bruce Poliquin (ME) cited one death per day in his state, and said that 6 out of every ten families are directly or indirectly impacted. “This is a rural crisis,” he said. Rep. Tom MacArthur (NJ) reported one death every 43 hours. Rep. Brad Schneider (IL), representing Illinois’ 10th District, including parts of Cook County, testified that in Cook County, which includes the city of Chicago, opioid overdoses increased by 87.4% between 2013 and 2016.
Rep. Ben Ray Lujan (AZ) said that “across this country, there were 52,404 deaths in 2015, and more than 560,000 deaths between 1999 and 2015, ten times those that died in Viet Nam.” Rep. Richard Hudson (NC), from a military district, said his is the 4th highest rate of opioid deaths in the nation. He said that opioids are killing more people than were dying at the peak of the HIV epidemic in the 1990s.
Rep. Joseph Kennedy (MA) called the crisis “personal, painful and petrifying.” He conveyed how he got into a fight with his doctor while on his hospital bed because he refused to take painkillers. He attacked the low Medicaid reimbursements and the criminal aspect of it: “We lock people up who are sick.”
Rep. Hakim Jeffries (NY) focused on the use of synthetic drugs by youths 12-18 years old. He said that this is “a malignant tumor eating away at young people,” and has “more than doubled in the last 10 years, and that the youth brain craves the drug and it can cause permanent brain damage” Rep. David Rouzer (NC) talked of “Narcan parties,” where people go to these parties knowing that by the end of the night they will be brought back to life by Narcan.
Rep. Evan Jenkins (WV) called his state “ground zero,” with the highest overdose rate, and highest rate of newborns exposed to substance abuse. Several lawmakers addressed the urgency to stop drug trafficking. As was cited by many representatives, drug overdoses now surpass car crashes, suicides and homicides combined, bringing it to be the leading cause of accidental deaths in the United States.
Whatever the real figures are, the bodies are mounting, and the epidemic shows no sign of decline. Minority Leader Rep Nancy Pelosi (CA) said that due to the “life and death nature of this crisis, this is only the second time she has testified in her leadership capacity.” She warned that this crisis is “taking a daily toll in every district of the country, claiming the lives of tens of thousands per year. “This is a public health catastrophe, “ and “a challenge to the conscience of the entire country.”
Most testimonies focused on opioid abuse based on physical pain, the over-supply of prescription drugs, high costs of treatments, and cuts in Medicaid, which push people onto the street to buy cheaper and stronger heroin. Much of this heroin, unbeknownst to them, and even to the dealer, is cut with fentanyl or carfentanyl, 50-100 times stronger than heroin. Rep Paul Tonko (NY) reported that 20% of those who need treatment are receiving it. Families are going broke trying to get their children sober, to the point of getting additional jobs and refinancing their homes. Drug abuse has cascading effects, as children are forced to care for themselves, occurrence of domestic violence, and people losing their jobs and homes.
Not Just Rural Areas: The Case of the Bronx
According to the New York Times of Oct. 15, “Overdoses in the Bronx Spur a Quiet, Brutal War”, although Staten Island has the highest overdose deaths in the five boroughs, the Bronx, especially the South Bronx, experienced a new surge at the turn of the decade. “People are dropping dead all over,” said resident Terrell Jones. “Regardless of how they died, it wasn’t an intentional death. Nobody woke up and said, “Today I want to die of an overdose.” “People have issues and reasons they’re using drugs, and it’s not for us to judge.” The increase in drugs is attributed to cheap heroin, laced with fentanyl. Jones said, I don’t leave my house without Naloxone (Narcan) in case of an overdose.
The Bronx is known to be an area of long-term addicts. When cheap heroin hits the streets, the fire is set. In 2016 there were double the overdoses of 2010; 85% involved opioids, 76% heroin/fentanyl. Some fentanyl is too strong for Narcan. Although groups have hit the streets with make-shift tents and vans to educate people, offer free Naloxone, and clean syringes, the deaths escalate.
This is a war and it can’t be won person by person. It can’t be fought on the streets. It must be fought top down. Referring to the 1980’s war on drugs, which was a crackdown on the small guy, Bronx resident Jones said he devotes himself to helping drug users. He sees a continuing double standard for Bronx residents who are stripped of compassion and dignity amidst an epidemic that has engendered sympathy and panic in other communities. From his vantage point, the attitude toward the opioid deaths today is still influenced by prejudicial attitudes about the crack and heroin epidemics before. “It’s just color. It’s like we’re part of a third-world country because we’re not part of the privileged class. I could be wrong, but I’m saying that it’s because of our color. It’s a big issue.”
New Hampshire Morgue – “The Visigoths at the Gates”
A New York Times article of Oct. 7 quoted Dr. Thomas Andrew from the state morgue in Concord, NH: “It’s almost as if the Visigoths are at the gates, and the gates are starting to crumble. I’m not an alarmist by nature, but this is not overhyped. It has completely overwhelmed us.“ He claims there are more synthetic opioid deaths per capita in New Hampshire than in any other state. The article reports that some medical examiners, especially in Ohio, have had to store their corpses in cold storage trailers in their parking lots.
Severe backlogs in autopsies can lead to the loss of state accreditation. A medical examiner’s office is considered deficient if an individual pathologist must perform more than 250 autopsies per year. Dr. Andrew and his deputy examiner have performed 250 each. Dr. Andrew spoke of carfentanyl, which he said is 10,000 times as potent as morphine. “We’re already so far behind the eight ball here, if we have an influx of carfentanyl in this state, heaven help us.”
Opioids drive Hepatitis C crisis
According to an Oct. 18 Washington Post article, the incidence of Hepatitis C has tripled over a few years, particularly from needles used among drug users in their 20-30s. West Virginia has the highest rates of overdose deaths, plus new Hepatitis C and B infections. The CDC reported that 34,000 people contacted hepatitis C in 2015. In Massachusetts 300,000 people are believed to have the disease, but half have not been formally diagnosed. In the case of hepatitis C, it’s possible for victims to not display symptoms until it is too late.
The public health consequences unleashed by the opioid epidemic go beyond the rise in overdoses. There has been an increase in hepatitis B and other sexually transmitted diseases, including syphilis and gonorrhea. There are elevated rates of endocarditis, an infection of the heart, and increase of emergency room visits for abscesses, hospitalization for soft tissue infections, even resulting in amputation.
Some places even show small increases in HIV. In Austin, Indiana, in 2014, 200 drug users got HIV from sharing needles. Estimates nationwide are that 3.5 million people have hepatitis C, and three-fourths are baby boomers. Of the twenty thousand who died in 2015, the majority were over 55, due to no screening until the 1990s. Many new carriers are now youth, due to intravenous drug use. In West Virginia, the incidence of hepatitis C is nine times the national average. Medicaid costs were $27 million in 2014-16, due to an increase in gonorrhea and syphilis due to drug use. Hepatitis C is 10 times more contagious than HIV, with long term consequences. It can also be passed to an infant during birth. There is severe denial, both among the users and the lawmakers. Everyone wants to believe that they can “play it safe,” while overall, the nation is dying.
What Is To Be Done
On Sunday, Oct. 15, the White House let it be known that President would finally declare the opioid epidemic a national emergency during the following week. That same day both the Washington Post and 60 Minutes dropped a political bombshell, with coverage of DEA whistleblower Joseph Rannazzisi exposing the fact that Congress had passed a law in April 2016 which weakened the agency’s ability to go after drug distributors.
The exposé sent lawmakers running for cover, especially Rep. Tom Marino (PA), who had been nominated to be Trump’s drug czar. Marino withdrew his name from consideration a mere 48 hours after the exposé. And Congressmen are rushing to reverse the legislation Marino had helped push through.
The emergency declaration will provide needed funds for treatment, but not deal with the roots of the crisis.
As I reported in my article on October 6, based on a report by two Ohio State University professors, the roots of this drug crisis are economic. Unless our nation returns to the policies that once made America great, and the basis of the American System of economics, no solution to this drug crisis will work. The optimism of a FDR-JFK recovery program is the only antidote that can succeed.
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