Tag: public health emergency

This Is No Time to Panic

The rising opioid overdose death rate is a serious problem and deserves serious attention. Yesterday, during his working vacation, President Trump convened a group of experts to give him a briefing on the issue and to suggest further action. Some, like New Jersey Governor Chris Christie, who heads the White House Drug Addiction Task Force, are calling for him to declare a “national public health emergency.” But calling it a “national emergency” is not helpful. It only fosters an air of panic, which all-too-often leads to hastily conceived policy decisions that are not evidence-based, and have deleterious unintended consequences.

While most states have made the opioid overdose antidote naloxone more readily available to patients and first responders, policies have mainly focused on health care practitioners trying to help their patients suffering from genuine pain, as well as efforts to cut back on the legal manufacture of opioid drugs.

For example, 49 states have established Prescription Drug Monitoring Programs (PDMPs) that monitor the prescriptions written by providers and filled by patients. These programs are aimed at getting physicians to reduce their prescription rate so they are not “outliers” in comparison with their peers. And they alert prescribers of patients who have filled multiple prescriptions within a given timeframe. In some states, the number of opioids that may be prescribed for most conditions is limited to a 7-day supply.

The Drug Enforcement Administration continues to seek ways to reduce the number of opioids produced legally, hoping to negatively impact the supply to the illegal market.

Meanwhile, as patients suffer needlessly, many in desperation seek relief in the illegal market where they are exposed to dangerous, often adulterated or tainted drugs, and oftentimes to heroin.

The CDC has reported that opioid prescriptions are consistently coming down, while the overdose rate keeps climbing and the drug predominantly responsible is now heroin. But the proposals we hear are more of the same.

We need a calmer, more deliberate and thoughtful reassessment of our policy towards the use of both licit and illicit drugs. Calling it a “national emergency” is not the way to do that.

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Poor Situation Management

Part of controlling the damage from disasters, terrorists attacks, and other national public incidents is controlling public reaction. So it is with the current swine flu “public health emergency.” So far, there have been twenty confirmed cases of swine flu in the United States.

In terms of managing reaction, there’s good and bad in the following quote from this morning’s Washington Post: “ ‘Clearly we all have individual responsibility for dealing with this situation,’ said deputy national security adviser John O. Brennan.”

The good: Brennan is correct on the merits. Controlling flu is mostly a matter of good hygiene.

The bad: A deputy national security adviser should not give quotes about flu outbreaks to a national newspaper. His title circumscribes his responsibilities, and he conveys wrongly by speaking about the matter that a (still largely potential) swine flu outbreak is a national security event. It is not under any reasonable definition of the phrase “national security.”

Just like the U.S. president shouldn’t be perceived as occupying himself with pirates off the Somali coast - the administration handled that situation well - a national security adviser should not weigh in on an inchoate outbreak of flu.

The result from suggesting that the flu affects national security could be more damage than the outbreak itself: canceled travel, reduced trade and commerce, pulling kids from school, staying home from work. An infantilized country is a weaker country, not a safer one.