Byron's Babbles

Thoughts From The Barn On The Opioid Crisis

Posted in Agriculture, Agriculture Science, Community, Convening, Culture, Dopesick, Leadership, Opioid Crisis by Dr. Byron L. Ernest on January 5, 2019

This morning I had a moment of reflection while caring for our dairy show heifers. We had some heifers dehorned this week and we then give them a pain/antibiotic bolus (what you would know as a pill) for five days. Just to be clear, removing horns while the calf is young and horns are small is important for the safety of the animal itself, the other animals, and those of us caring for them. After giving the boluses I thought about whether the pain pill was addictive like opioids. Then I thought, well this is irrelevant because our heifers won’t get addicted because they won’t get more than the prescribed dosage of our veterinarian. Then, I couldn’t help but think about the opioid crisis that is a very real and relevant problem in my own state of Indiana and the nation.

This caused me to go back and study the work of Beth Macy and author of the great book, Dopesick: Dealers, Doctors, and the Drug Company That Addicted America. I blogged about this book in Why Everyone Should Read Dopesick. The supply-side of the opioid issue is one that Macy has chronicled in detail. The supply-side narrative is much more complex for humans, however, than our show cattle, but the analogy helped me understand the messiness of the supply-side argument.

I learned from Macy that there are several parts to the opioid crisis. There is no doubt that companies like Purdue Pharma, the maker of OxyContin, profited from understating the addictive risks and forced high sales quotas on their salespeople. But, government regulations to limit supplies haven’t been successful solving the crisis. In the case of my cattle, I can control the supply and do what’s best for them. With people, however, it is much more complex. We cannot just stop the supply completely. One challenge with supply-side regulations has been people not being able to get the pain medications necessary. Targeting supply is very important, but we must still address the needs of people with real pain. I read about those that by battling the opioid epidemic that some patients who need opioids are being abandoned by their patients.

We really need to make sure our policies are not too draconian and that we really get to the root causes of addiction. Our country has become flooded with opioids and it has made for lots of literary works, but we need to make sure and learn who is most at risk of addiction and why. The other thing that has resonated in my studying of this issue is the disconnect between science and policy. Or, what I often describe as policy not meeting reality.

Additionally, another big obstacle to solving the crisis is that many local, state, and federal agencies and governments are more concerned about protecting turf and budgets than solving the problem and helping people. I’m not sure that technocracy can solve this issue. It is going to take intersectional thinking that includes mental health, physical health, housing, peer support, community, workforce development, education, and harm reduction.

While I believe in individualism and personal responsibility, we need to find ways help our addicted, limit supply to those who need the drugs and in the proper doses, and really get to the root causes of the crisis. Policy, knowledge, science, and reality need to come together.