Association for Public Policy Analysis & Management

The United States has a variety of legal and illegal drug markets, and more than its share of the evils of addiction, illicit trafficking, and drug-related incarceration. Opioids—including both illicitly manufactured heroin and fentanyl compounds and prescription drugs such as oxycodone—are on the policy agenda for a grim reason: the United States is facing a massive epidemic, with the rapidly rising death toll now great enough to contribute to falling overall life expectancies. Better opioid policies would curb the over-aggressive marketing and prescribing of opioids that helped create the current problem without going back to the days when patients suffered needlessly from untreated or undertreated pain; they would also improve addiction treatment and make it more widely available, and offer better therapy to those who suffer from chronic pain.

An estimated two million Americans suffer from opioid abuse disorders, and in 2015, 32,000 died of opioid overdoses—nearly as many as died in car crashes and more than twice the number killed in homicides. The abuse of prescription opioids, including hydrocodone (sold as Vicodin or Lortab) and oxycodone (or Percodan, Percocet, and Oxycontin), began to grow rapidly in the early 1990s; the annual count of people reporting first-time nonmedical use of opioids rose from around 200,000 in 1992 to more than 2.4 million a decade later, exceeding the comparable figure for cannabis. Rising supplies of prescribed opioids helped create a black market and penetrated populations left largely untouched by heroin.

Policymakers and health-care providers have several options to tackle the opioid crisis. None offers a miracle cure, and each involves either spending money or imposing and enforcing regulations. The quickest way to save lives is probably to expand access to “antagonist” drugs, which can bring overdose victims back from the brink of death. These drugs, such as naloxone (sold as Narcan), save thousands of lives every year. Naloxone is now available as a nasal spray, and it requires no medical training on the part of the person administering it. Changes in policy have made antagonists easier to obtain legally and have put them in the hands of police and emergency medical technicians, and aggressive public information campaigns have spread the word that an overdose is reversible if first responders (or the opioid user him- or herself, a friend, or a passerby) can administer an antagonist quickly.

But reversing an overdose is only a start; many users overdose more than once. Last April, for instance, naloxone was used to revive the music icon Prince; one week later, he overdosed again, with no one around this time to administer the antidote.

It is conceivable that more effective and less risky drugs or drug combinations could be designed for pain relief and addiction treatment. But doing so would probably require changing both FDA drug-approval policies and the way drug development is now financed.