A law with unexpected consequences


In a makeshift Touro College courtroom, the roots of the current opioid epidemic are dissected in the first such case in the country to pass before a jury. Three manufacturers and a drug distributor continue to claim that the wave of drug addiction and death that has plagued the island for a decade is not due to their aggressive marketing and sales of prescription painkillers.

The fact that several co-defendants have settled with the state, bringing a total of around $ 200 million to Nassau and Suffolk counties, does not strengthen their case.

But four years before the complaint was filed, New York adopted the Internet prescription tracking system, ISTOP, to stem the carnage. Pharmaceutical companies had convinced the FDA, doctors and pharmacists that the newly developed opioids presented little risk of addiction to patients with pain and could be prescribed generously and safely.

This was not true, and the permissive environment had devastating effects. Many patients, oblivious to the dangers or vulnerable due to previous addiction issues, became addicted and began to seek prescriptions from several doctors and pharmacies. Many doctors have over-prescribed out of a sincere desire to help. Other doctors became addicted to the quick money they could make writing prescriptions for painkillers for cash and authorized millions of lethal doses.

And the black market was quickly inundated with cheap prescription opioids.

ISTOP, which required patients, doctors and pharmacies to be monitored online in real time to stop doctor buying, pill mills and other abuse, was a response.

The law worked as intended, helping stem the tide of new addictions.

But it also had unintended consequences. Some people who died of heroin and fentanyl overdoses after ISTOP would likely be alive if the pill supply had not been so dramatically reduced, pushing opioid addicts off the street.

Overdose deaths are accidents, which occur when users inadvertently ingest too much. Prescription pain relievers are predictable for all their ailments. A certain dose of oxycontin has a certain effect, and regular users know what to expect.

But users who buy heroin cannot know what they are getting. Cheap, potent and deadly fentanyl has become the drug of choice for heroin-cutting dealers and a skyrocketing cause of death. And thousands of Long Islanders have died.

The issue is the law of unintended consequences, not blame. ISTOP was well intentioned and effective, but addiction is a bearish.

It is accepted wisdom, and it is true, that drug prevention should be a priority because drug treatment is so often unsuccessful. It is essential to convince people to stay away from the deadliest intoxicants and to beware of the milder and legal ones.

But drug prevention must also become something deeper.

We need to explain why so many people, and often very young people, suffer so emotionally that they cannot bear to be sober. Seeing the number of fatal overdoses spiraling during the pandemic after their decline reminds us of how closely drug addiction is linked to pain.

Nourishing love can help prevent addiction. The same goes for a sense of belonging, a sense of usefulness, a dedication to a higher cause. Trustworthy spiritual institutions can bring comfort otherwise sought after in a needle or a pipe. Mentors too.

Our society itself is growing sicker and sicker: superficial and selfish and self-glorifying and angry, disconnected and materialistic and cruel. It is a painful way of living.

And tackling that is probably the only way to fight addiction that won’t have unintended and negative consequences.

Columnist Lane Filler’s opinions are his.


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