Insight, analysis & opinion from Joe Paduda


Lock ’em up!

In the State of the Union address, President Trump said:

“We must get much tougher on drug dealers and pushers if we are going to succeed in stopping this scourge,”

There was only a passing reference to treatment, and there’s been no appreciable effort from the White House to expand treatment.

That approach has not and will not work. Period.

Equally troubling, the White House has sidelined professionals in favor of political appointees with little knowledge of or experience in dealing with opioids, the opioid crisis, pain management, or treatment. Politico:

“Among the people working on the public education campaign that Trump promised is Andrew Giuliani, Rudy Giuliani’s 32-year-old son, who is a White House public liaison and has no background in drug policy…”

This is both personal and professional for me.

A family member in law enforcement ran a drug task force in a major city.  He died in the line of duty, leaving a gaping hole that will forever be an unbearable burden.

Our daughter and her husband deal with the opioid crisis every day in their jobs working in Emergency Departments. They see the futility of enforcement-based approaches several times each shift, and it is a crushing burden.

Patients with Substance Abuse Disorder (SAD) will do anything to or for anyone to get their drugs. Prostituting their kids, stealing from parents, abandoning their families…if people will do this, the risk of a jail sentence is NOT going to get them to stop taking opioids.

And the suppliers are making hundreds of millions of dollars every week…Nothing will prevent new ones from replacing any pushers unlucky or stupid enough to get caught.

The problem is both demand and supply.

Supply can be laid directly at the feet of opioid manufacturers and distributors. They lied, they knew they were lying, and they kept lying about the addictive risk of opioids. They convinced prescribers that addiction risk was so low as to be unimportant for patients that “truly had pain.”

Now that they’ve created demand – millions of users, they stand aside, blaming their victims for using the products pharma knew would cause addiction. Unable to obtain prescription opioids, users switch to heroin.

Purdue, Endo, J&J, and other opioid manufacturers created an incredibly “loyal” customer population of patients who will do anything to get their drugs.

We desperately need a major expansion of treatment programs and funding for those programs.

We do NOT need any more dead law enforcement officers, burnt-out first responders, bankrupt governments, profiteering private prison operators, devastated communities and ruined families.

But that’s exactly what we’ll get with a law enforcement approach to opioids.

I am deeply troubled that the President has done nothing to increase treatment, to add funding, to staff the Office of National Drug Control policy with people who have a clue.

The Administration has not appointed a director for ONDCP. A young man with no credentials or experience or demonstrable ability was the Deputy Director of ONDCP. The President’s budget proposed slashing ONDCP funding by 95%, a move that prompted fellow Republicans to promise to fight the cuts.

One example is telling. A program slated for major change is the High Intensity Drug Trafficking Initiative, the single most important program focused on fentanyl. According to one expert, moving the program out of ONDCP;

“does not make practical sense. Imagine taking the responsibility of emergency response away from the CDC in the middle of the Ebola emergency. It would never happen,”

What does this mean?

Without a focus on treatment, there is no change.

12 thoughts on “Lock ’em up!”

  1. I agree that treatment is key, but we must also continue to fight to have congress prosecute the pharmaceutical companies that not only started this crisis, but continue to supply it with more and more victims.

  2. Hey Joe. great article and couldn’t agree more but the “supply” part of the equation includes the providers. they are plenty smart enough to know better than what the manufacturers tell them about the drugs they make. that’s been around for some time. States are doing enough to enforce things in place such as adoption of the PMP or restricting licensing where there are patterns of behavior. LA passes a law that mirrored the CDC 7 day recommendation for acute pain but in the bill the provider can go around that provision with just documentation in the patients chart. the representative sponsoring the bill for the governor refused to amend the bill. Another bill expanded access to the PMP but did not penalize the provider for not checking the database. Something is better than nothing but we can do better. Lets hold the providers more accountable and quit worrying about hurting their feelings! Ok I will stop. T

    1. Troy – as you are one of the folks on the front lines, I listen closely to your views. Completely agree with your observations about the prescribers!

    2. So true, I review a lot of medical reports from the Pain Management providers. They have now added a boiler plate statement to all their reports, and I paraphrase, that states, the patient is not showing any adverse affects; but that I the provider have addressed that these medications may have adverse affects on your health including death. This is outrageous, these are patients taking opioids and benzodiazepines concurrently and at the prescribed dosages, its not about overdosing, its that they can just stop breathing and die while in their sleep.

  3. There was a good show on Sirius Radio show: Main Street Meets the Beltway with Jeff Sessions. It was a candid interview and he gave some good points on how the USA can fight the opioid epidemic. Again the President and his Cabinet leaders are on different pages. #sad

  4. Not only is there no effort from the Administration on the treatment side, KellyAnne Conway who is apparently the point person in the White House has convened meetings on the subject and the experts on the subject have not been invited to participate. There have been proposals to reduce funding in this area. The deaths we have experienced and continue to experience far exceed any deaths from terrorism, deaths from all of the military conflicts we have engaged in, and we cannot blame this on foreign or homegrown terrorists. The threat to our country from these drug pushers in suits and lab coats is far greater than any threat an expensive wall might address. And I would like to see the $25 billion being asked for a wall instead be used for treatment to mitigate this much more serious problem.

  5. Let’s get real. Big Pharma has the money which means they have the power. This government will talk the talk, but they won’t walk the walk.

  6. All great points, and I see the AMA is addressing this with the providers. You can manufacture millions of oxycontin doses but if there are no prescriptions no one can get them. The providers writing the prescriptions are the point of the spear. The rest of the folks down the supply and manufacturing chain will have to be made responsible for the detox and rehabilitation of all these addicts. Now I find out that China is supplying Fentanyl and even more powerful narcotics via US Postal Service, purchased online. The system to track and interdict is non-existent so for the addict that is cutoff by the provider the streets are full of ready made doses of heroin and fentanyl mixed into a deadly combination. We have decades of work to do to clean up this mess, but how do we keep the focus?

  7. Thanks for lucid column and responses.
    I had stopped using the word “unbelievable” because the Trump administration and Republican congress has stretched-broken credulity almost every day, but how they are botching the opioid mess is unbelievable.

  8. Great thoughts and an important focus on widening the dialog beyond just the “opioid epidemic” buzzword.

    It’s important in any discussion to remember the people behind the addictions and what led them there. Criminalizing pain won’t solve anything. We have to offer solutions to those already addicted while tackling the larger problems that lead to drug abuse with new treatment paradigms. For instance, maybe in terms of pain, we have to look at options like neuromodulation and behavioral health as greater parts of the treatment algorithm.

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Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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