Congress is forging ahead on legislation to reduce addiction and death caused by opioids, and the legislative body is now touting a mantra that addiction is a disease rather than a moral failing.
“Substance use disorder is a medical illness and we must treat it that way,” House Energy and Commerce Committee Chairman Greg Walden, R-Ore., said during a March legislative hearing.
That attitude has touched not only opioid legislation, which Walden hopes will pass in the lower chamber by Memorial Day, but other areas of policy-making as well. Congressional Republicans now reject requiring drug testing as a condition for people to receive food stamps.
It’s a shift from the approaches of the 1980s and 1990s, when the “War on Drugs” centered on law enforcement and drug prohibition. Opponents to that approach have largely concluded that the efforts failed and charge that racism played a role.
Experts say a combination of factors has led to the shift in thinking: research on addiction has improved, and there is a new focus on the root cause of opioid addiction–often legal prescriptions evolving into a seemingly unbreakable habit–have shifted the conversation. The opioid epidemic is also the deadliest of all illegal drug epidemics in the U.S., and effective treatment through medication is available.
“The answer back in the early days was to throw everybody in jail,” said Rep. Brett Guthrie, R-Ky., who admitted that his thinking on the issue changed after talking to constituents. Previously, he had supported a stronger police approach against individuals selling drugs.
“What I learned is that there are people who get into the position of selling not because they are distributors but just because they are supporting their own habit,” he said. “When you start hearing stories, it’s not always black and white, sometimes there is some gray. And so you can give some people the benefit of the doubt in it.”
More than 42,000 people died from an opioid overdose in 2016, a death toll showing a five-fold increase in less than two decades. Federal data indicates that more than 2 million people have an opioid addiction, but less than 20 percent receive treatment.
Though President Trump has received criticism for his rhetoric on the opioid crisis involving a call for tougher penalties on drug traffickers, his opioid blueprint contained strategies to prevent overdose deaths and provide more access to medical treatment.
Health and Human Services Secretary Alex Azar has made tackling the opioid crisis a top priority, declaring that it is “not a moral failing,” and Dr. Brett Giroir, who is leading opioid policy at HHS, called the crisis the “greatest public health challenge of our time.”
Surgeon General Jerome Adams, who has spoken about his brother’s battle with substance abuse, told the Washington Examiner in a recent interview that stigma against addiction was one of the largest issues to tackle.
Some of the change in tone has to do with the causes of the opioid epidemic, lawmakers said. Opioids include illegal drugs such as heroin and also prescription pain relievers like Vicodin and OxyContin. Patients were prescribed painkillers and then, addicted, turned to heroin, a cheaper, more available alternative. According to federal data, 80 percent of people who abuse heroin first abused prescription painkillers.
“They were doing what their doctors told them to do and then they ended up with a serious addiction,” said Rep. Morgan Griffith, R-Va. “I think we have to treat it as a disease … It is affecting all of our districts and we all know somebody in our communities who has lost a loved one or has somebody who is greatly affected.”
In a recent Energy and Commerce Committee roundtable, various participants described how they or a relative became hooked on drugs through prescriptions from a doctor. Those stories have affected how lawmakers tackle the issue.
“As we heard during the round table, there are many aspects that factor into opioid abuse, including mental health,” said Rep. Michael Burgess, R-Texas, chairman of the health subcommittee. “In our ongoing effort to find solutions, Congress is taking into account all possible answers to this epidemic, from prevention and treatment to enforcement and care.”
Rep. Frank Pallone, D-N.J., the top Democrat on the Energy and Commerce Committee, said both parties reached the consensus that addiction was a disease.
“People take prescription drugs because of trauma or other types of pain and they get addicted through no fault of their own,” he said.
Lawmakers also said they have learned more about addiction; sometimes citing research showing that when people are addicted to a substance, the circuits in their brain are disrupted, making it more difficult to control impulses.
“I do believe it is a disease because of the science behind it, because of what the drug does to your dopamine process,” said Rep. Richard Hudson, R-N.C. “What I have learned as I visited treatment centers in my district and talked to folks is that it can take your brain up to two to three years to reprogram the way the dopamine process usually works. And so just putting someone in a 12-week treatment plan and turning them loose on the world is not going to work. You’ve actually got to have that recovery time. There is a lot of science behind it that I think as we learn more about it we look at it differently.”
Dr. Paul Earley, president-elect of the American Society of Addiction Medicine, said that treating addiction as a moral failing occurred historically partially because of the “collateral damage” that comes from drug abuse.
“The damage to society, the criminal behavior, the theft, the wrecking of cars,” he said. “It’s easy to extrapolate that into issues that fall into the lines of legal or moral failings versus biochemical failings.”
Officials have described addiction as a chronic brain disease and have said it can be managed with medication and lifestyle changes, similar to diabetes. Earley said studies showing half of addiction cases could be tied to genetics also contributed to the new understanding. The other half of cases are caused by environmental factors, access to substances, trauma or psychiatric conditions, he added.
Experts recommend doctors prescribe medications, such as buprenorphine, to help people with addictions stave off painful withdrawal symptoms.
“That fact also tends to make people say, ‘OK, so my high blood pressure is treated with a pill, and you can actually treat this with a pill, so maybe it is a disease,'” Earley said.
Despite changes in attitudes by policymakers, the public is split on the issue. A recent poll by the Associated Press-NORC Center for Public Affairs Research found that fewer than 1 in 5 respondents were willing to closely associate with someone who had a drug addiction. Still, a slim majority, 53 percent, said they viewed addiction as a medical problem.
“This is the only thing that I can see that is positive in this horrific epidemic that we have, that people are seeing addiction as a biological disease,” Earley said.