"I’m not given to hyperbole, but it actually is a crisis," Mr. Chuck Rosenberg recently told Pacific Council members, referring to opioid abuse in the United States.
Rosenberg served as President Obama’s acting administrator of the Drug Enforcement Administration (DEA) from 2015 to 2017, chief of staff to FBI Director James Comey from 2013 to 2015, and counsel to FBI Director Robert Mueller from 2002 to 2003. He also served as the U.S. Attorney in the Eastern District of Virginia and Southern District of Texas during the Bush administration.
In a discussion with Council members, Rosenberg discussed the opioid crisis, the future of pharmaceuticals, and the drug crisis’ connection to Mexico. Moderating the discussion was Jessica Yellin, senior fellow at the USC Annenberg Center on Communication Leadership & Policy and former chief White House correspondent for CNN.
Rosenberg pointed to striking numbers when discussing the crisis: about 67,000 people will die this year from a drug overdose. That’s 180 people a day losing their lives, 60 percent of which are opioid related. In comparison, approximately 30,000 die each year from firearms and the same number from car accidents.
"While overwhelming numbers of doctors and pharmacists have the best intentions for their patients, collectively, we have failed."
The numbers are staggering, especially considering the comparison between the United States and other countries. Americans make up just 5 percent of the world’s population, yet account for 99 percent of the world’s hydrocodone and 80 percent of its oxycodone use.
"We end up with millions of pills in medicine cabinets around the country, and that’s part of the problem," Rosenberg said.
So how did we get here?
Rosenberg noted that while overwhelming numbers of doctors and pharmacists have the best intentions for their patients, "collectively, we have failed."
In the United States, four out of five heroin users started on pills that were obtained lawfully in the first instance, such as through a prescription from a doctor. On top of that, there has been a recent influx of synthetic opioids from China, including the deadly synthetic fentanyl, which Rosenberg described as 50 times stronger than heroin, and carfentanil, which is 100 times stronger than fentanyl.
"The demand for drugs in the United States is making life miserable for millions of Mexicans, and we should be absolutely clear regarding who’s at fault: It’s us. We are the ones seeking this poison."
While fentanyl can have a legitimate purpose in treating pain, the fentanyl that is causing problems is synthetic and manufactured in China, shipped to Mexico, and often laced into the heroin that is then shipped from Mexico to the United States, causing a spike in overdoses.
The immigration debate has exacerbated the discussion on the opioid crisis, with politicians blaming Mexican immigrants for smuggling drugs into the United States. However, Rosenberg said that’s not entirely accurate.
He noted that by and large drugs are being shipped by sophisticated cartels, not immigrants trying to come into the country. In fact, Rosenberg didn't place all of the blame on Mexico or its government, but suggested the United States look in the mirror.
"The demand for drugs in the United States is making life miserable for millions of Mexicans, and we should be absolutely clear regarding who’s at fault: It’s us," he said. "We are the ones seeking this poison."
"We’re not going to solve a public health crisis by putting addicts in jail."
But who can be blamed within the United States? The answer is complicated.
"I think we’re all at fault," Rosenberg said. "Well-intentioned doctors are overprescribing. Patients don’t want to be in pain and are inclined to take what doctors give them. And pharmaceutical companies are making a lot of money off lawful products."
But the current culture of criminalizing addicts is unhelpful in addressing the core issue. "We’re not going to solve a public health crisis by putting addicts in jail," he said.
Rosenberg is proud of the work he has done in law enforcement and noted that we should be careful in how we treat addicts, those who he considers are "at the bottom of the drug chain," as opposed to cartels and high-level drug traffickers.
"I’m not a political person, but we have spent a long time in law enforcement trying to build relationships in communities that need law enforcement services. These relationships are absolutely critical," Rosenberg said.
Twice a year, the DEA sponsors the National Takeback Program to help Americans clean out their medicine cabinets and dispose of prescription medication anonymously and safely.
Additionally, it is easy for Americans to view the drug problem as only affecting a small portion of the population in rural communities. But Rosenberg stressed that with 600 new heroin addicts a day, addiction is "not just a rural disease," but also an urban disease, a West Coast disease, and an East Coast disease.
So what should the United States do moving forward? How can and should this public health crisis be addressed?
Rosenberg recommended a mandatory prescription drug monitoring program, which is essentially comprised of a uniform national database of patients, prescriptions, pharmacies, and doctors to track opioid use.
He also pointed to a program created by the DEA of which he is particularly proud. Twice a year, the DEA sponsors the National Takeback Program to help Americans clean out their medicine cabinets and dispose of prescription medication anonymously and safely.
The DEA has also partnered with Discovery Education and created a free STEM-based curriculum available to all middle and high schools in both English and Spanish, where educators can teach the science of opioid addiction in the classroom.
"We can reduce demand if we think holistically about how we change the culture. We might be heading in the right direction. Prescriptions for opioids appear to be turning down for the first time. Hopefully, it’s a lasting trend."
One attendee asked if it was possible to change the culture in the United States in relation to drug use.
"I think the answer is yes," Rosenberg said. The country can "reduce demand if we think holistically about how we change the culture." He pointed to past successes in reducing teenage smoking and encouraging seatbelt use as examples of the potential to change behavior and culture and thus the way Americans abuse dangerous drugs.
"We might be heading in the right direction," Rosenberg said. "Prescriptions for opioids appear to be turning down for the first time. Hopefully, it’s a lasting trend."
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