The opioid crisis and modern drug dealers

We are all struggling with the tsunami of drug use and addiction in Alaska. The paper has a new shooting or drug-related violent crime as a news report almost every day. One of the recent proposals to deal with the wave of drug-related crimes in Alaska was to get tougher on the criminals. One recent proposal is to charge individuals with a felony as “drug dealers” if they are apprehended with drugs in quantities deemed likely related to personal use on two or more occasions. This won’t help. Jail doesn’t work. Treatment does.

Read the plethora of articles on just how effective Portugal’s approach to the opioid issue was in their country. Treated as a public health issue, drug use dropped significantly; their epidemic was brought under control and incarceration rates were markedly decreased. If you search online for “Portugal and their opiate epidemic,” there are multiple articles from a variety of mainstream magazines, as well as medical journals. Portugal wasn’t the first country to try new approaches to the opiate problem. But the approach Portugal used worked the best. What we’re doing doesn’t work, we know it, and it is a choice. We should make better choices.

Every epidemic has a cause. Typically, the successful approach has been to identify the cause and then look for ways to prevent new cases while providing treatment for existing cases. Seems straightforward. It worked with the plague, polio, syphilis and other transmitted diseases. Even with AIDS, after we got over the fact that whispering about HIV and not screening because of the sexual component wasn’t working, the medical profession got on it. Dealing with an epidemic as a public health issue works.

The current opioid epidemic is caused by the widespread use of opiates. Opiates were derived from the opium poppy. Recognized hundreds of years ago, before the time of Hippocrates, milk of the poppy was known to dull pain and bring on sleep — but could bring on too much sleep and kill you. If we humans knew hundreds of years ago how destructive opiates can be outside of a narrow frame of usage, why are we doing this? That’s where the discussion of vectors comes in. Causative agents in epidemics are carried by rats, mosquitoes, saliva, stool, or with the opioid epidemic, drug dealers. If we know the vectors are drug dealers, why aren’t we addressing this? The vector is not the individual addicted to opiates and scrabbling around in a world of drug chaos trying to find the next dose. It’s the big-time drug dealers. We tend to think of the drug dealers as gangster-style “bosses” with “mules” who are opiate users themselves, forced into servitude to support their habits.

The U.S. has been very determined to find the drug dealers poisoning our country and particularly our most vulnerable, the young. There have been some notorious dealers, like El Chapo, who was estimated to be worth about $16 billion by a 2016 report. He’s in jail. He was always destined to be on the run, rich or in jail. He did it all. The U.S. government spent time and big bucks to run him down.

El Chapo’s drug-dealing elite status was eclipsed by the Sackler family. They are reported by Forbes as being among the 20 richest members of the elite billionaire club of America. What did they invent? Nothing. They just peddled their form of milk of the poppy wearing expensive suits and peddling their drugs through the U.S. government. The Sacklers have peers among the pharmaceutical CEOs but none have been as successful. In case you don’t know who the Sacklers are, they are “legalized” drug dealers who operate under the name of Purdue. That’s a company exclusively owned by this family of eight, and their product has crippled this country. They didn’t do their marketing with guns or in sleazy after-hour bars and alleys. They went straight to Congress, the Food and Drug Administration and the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO. They sent marketers to doctors, nurse practitioners and physician assistants, anyone who could write prescriptions. They nurtured enabling behavior by pharmacists and nurses. They made bogus claims, convinced the uninformed and carried out the biggest modern-day racketeering scam ever.

The Sacklers started out by going to medical school. They went into psychiatry. They then studied advertising and pharmaceuticals. They initially promoted Valium. They advertised for the company that made Valium and were so successful at its marketing it became the No. 1 prescription in the U.S. No kidding: It calms you and then, with recurrent use, is addicting. You would think as psychiatrists, they would know that. I think they did. They then started their own line of addiction drug-dealing under the name of Purdue. Oxycodone was their drug. They took the long-acting ingredient in long-acting morphine, added that to oxycodone and landed on the big money maker Oxycontin. They gave a grant to JCAHO, a private “non-profit” entity entitled by our U.S. health care system to determine hospital activities as good or bad. The grant the Sacklers gave was to identify the need for more pain medication. And the hospital push was on. The Sacklers, also known as Purdue, got a huge return on the “grant,” which was just the cost of doing marketing.

Four out of five heroin users in the U.S. were habituated to drugs through prescription drugs. Prescribers were the mules. Treating the users at the end of this sad road to death and destruction with jail time won’t work. Jail the dealers. Address the individuals with the FDA who turned the other way and paved the path for approval and promotion. Read The New Yorker magazine article titled “The Family That Built An Empire Of Pain." And for heaven’s sake, we have 4.7% of the world’s population but 70% of the world’s lawyers, and suing is the revenue source, but treat dealers the same. What’s good for El Chapo is good for the Sacklers. Garnish their money, homes and belongings and toss them in jail.

As for the users and addicts, substitute treatment for jail. Oh, and what of the vectors, the prescribers? We have the Prescription Drug Monitoring Program, a tracking avenue. Put it to use. Take away their pens. Take away their licenses.

Martha Tillion Cotten, M.D., is a a primary care physician who has worked in both clinics and emergency rooms. She lives in Anchorage.

The views expressed here are the writer’s and are not necessarily endorsed by the Anchorage Daily News, which welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary(at)adn.com. Send submissions shorter than 200 words to letters@adn.com or click here to submit via any web browser. Read our full guidelines for letters and commentaries here.