Making a Murderer: Empty threats in Trump’s misdirected opioid war

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For more than a year, Donald Trump paid lip service to victims of the opioid crisis. As he grandstanded to his base about the problem, more than 100,000 people died of drug overdoses in what he labeled a “public health emergency” even while he chose not to release any additional funds for this emergency. And even though Congress finally included in its late-February budget deal $6 billion to address the epidemic, the President has adopted a Philippines-style law-and-order approach that he says now includes seeking the death penalty for drug dealers.

Let’s forget for a moment the plainly racist legacy of the failed War on Drugs. Let’s also ignore how costly and ineffective the death penalty is, with 88 percent of criminologists agreeing it does not act as a deterrent. There are a number of other ethical problems with Trump’s opioid approach. His fixation on the supply-side source of the epidemic has routinely included scapegoating Mexico, an obvious target that fits seamlessly with his “build The Wall” movement that’s rallied on all varieties of xenophobia since his early campaign days.

But building a wall or otherwise tightening security between the U.S. and Mexico is likely to have little effect on the continuing trend of overdoses. For one, according to the Center for Disease Control and Prevention, nearly half of opioid deaths in 2016 were the result of prescribed opioids not including those categorized as illicit such as fentanyl or heroin. If Trump wants a scapegoat for these deaths, he’s going to have to target the doctors who are likely practicing patient-centered care to those in pain. That’s not to say prescribing doctors are blameless in this epidemic, but it does highlight the quandary of confounding substances when speaking of opioid deaths using blanket terminology.

Secondly, as a foreign source, Mexico is often just an intermediary, with China producing the majority of fentanyl coming into the U.S. Far from the image of contraband smuggled into the U.S. through a loose Mexican border, the internet and dark web provide easy access to fentanyl that can be shipped directly to U.S. consumers and forego the type of drug dealer Trump has made a target of his opioid war.

Another ethical problem with Trump’s supply-side preoccupation is that it diverts funding that could be better spent on the root of the problem: the biochemical processes that cause dependence, overdose, and death from consumption. Naloxone, a medication that blocks the effects of opioids, was developed over 50 years ago and according to the CDC, tens of thousands of overdoses have been reversed using it. The fact that we are relying on science from 1961 should be evidence enough that developing more advanced pharmacokinetic solutions to opioids should be a priority. From 2014 to 2016, the price for a package of Naloxone increased from $690 to $4,500. If Trump is serious about preventing opioid deaths, addressing access to lifesaving treatments should be his most immediate concern.

Demonizing drug dealers is easy, plays well with the public, and draws a clear “us versus them” dichotomy. But the more nuanced reality is that many street dealers are addicts themselves and dealing is often a last resort to fund unsustainable chemical dependence. By the time many addicts have resorted to selling, it’s because they’ve been unable to maintain jobs, have lost control of their lives, and have reached the near-end of an unmanageable cycle. Threatening them with the death penalty is not a tenable solution and only increases stigma that might prevent them from seeking help. Further, it’s a vacuous warning when so many of the actual “dealers” are just dark-web commerce sites that deliver directly to consumers’ doors through the postal service.

With $6 billion to spend on the opioid problem, the repetitive Band-Aid of law enforcement and execution of drug dealers shouldn’t be the articulated priority of the Trump administration. Only funding science to develop interventions and medications to treat addiction and prevent overdose deaths can stop the opioid epidemic at its root.

– Tyler

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Access and allies

The Food and Drug Administration has revised the guidelines for a pill that induces abortion. The changes allow women to take the pill further into their pregnancy and reduced the number of required visits to the doctor. The pill, mifepristone has increased in use in recent years, and the debate over their use from anti-abortion leaders has heightened in parallel.

The new guidelines reduce the number of required visits from 3 to 2 and allow the medication to be taken up to 10 weeks into pregnancy, up 7. This has in fact been standard practice in most states as doctors have been following the new research and prescribing in line with that evidence under the common practice of off label use. Many states have passed laws to restrict the use of the pill since it was approved by the FDA.

These laws include requiring the pill to be administered by physicians rather than nurses or physician assistants, or requiring the prescribing doctor be present with the patient while the pill is taken which abortion rights activists point out as a strategy to block many women living in rural areas to receive the medication at all. Some states required that physicians follow the label instructions strictly, so the new language from the FDA could have a real impact.

In 2014, a mother of three in rural town Pennsylvania went to jail for ordering mifepristone online to induce a miscarriage for her 16 year old daughter. The nearest clinic to their home was about 75 miles away and  Pennsylvania requires women seeking abortions to get counseling and wait 24 hours before they can return for the procedure. A first-trimester abortion is typically between $300 and $600 and that does not include the added costs of time off work and travel. To order this pill cost this family $45.  This mother was charged with a felony for offering medical consultation about abortion without license and three misdemeanors for endangering the welfare of a child, dispensing drugs without being a pharmacist and assault.

Bioethicists, when discussing abortion, can often get mired in questions on personhood and the moral status of a fetus. Legal questions usually cover the rights granted to a fetus. This post takes for granted that abortion is part of medical practice and care for women in the United States and asks us to weigh the risks of the use of this pill without direct presence of a physician versus the large need for resources related to abortion for those who are lower income, or living in rural areas far from available clinics. It also brings to light the systemic criminal treatment of those who seek this abortions.

-Grace