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A six-part strategy to stop the addiction fatality epidemic: Guest commentary
By RET. ADM. JAMES A. "SANDY" WINNEFELD, JR.|August 22, 2018
Sandy, Jonathan, and Mary Winnefeld at Denver University in September 2017, a week before Jonathan's death.
S.A.F.E. Project US
Quick Takeaway
  • "We must raise public awareness of who the enemy really is—and is not."
  • "We need to amplify existing prevention efforts."
  • "A proliferation of prescription painkillers is a key entry point into dependence and overdose fatalities."
  • We need "a smarter commitment of both soft and hard power against both prescription and non-prescription opioids."
  • We need to get "those suffering with substance use disorder into, through, and beyond treatment programs."
  • "We need to do more for families struggling with the disease of substance use disorder."

Young Americans in uniform deployed overseas to fight terrorism are returning home to find their nation utterly losing a completely different battle.

Prescription and non-prescription drug overdoses are now the leading cause of death for Americans under 50-years old. The Centers for Disease Control and Prevention has just released preliminary findings that approximately 72,000 Americans lost their lives to drug overdose in 2017. This reflects a nearly ten percent increase from 2016 and, for more shocking perspective, is more than twenty times the number of Americans killed on 9/11.

My son, Jonathan, is one of those statistics. He was killed last fall, age 19, not by a foreign enemy but by a domestic one in Denver, Colorado, after spending 16 months in recovery.

Ret. Adm. James A. “Sandy” Winnefeld in 2018 (Photo: S.A.F.E. Project US)

If we are willing to risk brave men and women and spend many tens of billions of dollars fighting terrorism, then we should be equally committed to defeating this threat, which is killing far more of our people. It is also imposing other unacceptable costs on our society, including a half-trillion dollar-per-year drain on our economy; 85,000 kids placed in foster care each year; and an opioid-addicted baby born every half-hour in the United States.

Judges skeptical in case alleging criminalization of addiction

Like countering terrorism, reversing the tide of the addiction epidemic will require sophisticated thinking about strategy and thoughtful application of soft- and hard-power. It will require concerted efforts along six deeply interwoven lines of operation.

1. Awareness: We must apply more resources and creativity toward raising public awareness of who the enemy really is—and is not—in this fight.

Nobody grows up wanting to be an addict. Yet addiction is mostly misunderstood as a moral failing, rather than as a pernicious disease that humans are poorly equipped to battle. This leads to demand-reduction strategies that stigmatize—and ultimately criminalize—the user. It is telling that of the approximately 1.5 million people arrested annually for a drug-related offense, 85 percent of those arrests are for individual drug possession. And the stigma of addiction prevents many from seeking the treatment that could pull them out of the disease’s deadly spiral. If our nation is to get behind this effort, it must better understand the problem. 

2. Prevention: We need to amplify existing, full-spectrum prevention efforts.

While a national campaign would be ideal, lukewarm senior-leader interest, bureaucracy, and paltry funding will likely inhibit it.

While a national campaign would be ideal, lukewarm senior-leader interest, bureaucracy, and paltry funding will likely inhibit it.  Rather, prevention will mostly occur at the state and local levels.

Statistics show that young people between the ages of 18 and 25 are least likely to view drug usage as risky behavior. Community-led efforts to reverse this will be vital, in which credible voices speak directly to the right audiences and point out the causes and costs of addiction.

This kind of soft power demands rejuvenated drug education programs, beginning in elementary school. Finally, we must also firmly re-establish vigilant security in our middle schools and high schools, as well as college, where drugs are easily available right on campus.

3. Prescription Medicine:  A proliferation of prescription painkillers is a key entry point into substance dependence and overdose fatalities.

A proliferation of prescription painkillers is a key entry point into substance dependence and overdose fatalities.

Big Pharma, which is just now coming to grips with the potential hard power of expensive civil and criminal consequences, needs to wake up to the fact that it is beginning to look a lot like Big Tobacco did a couple of decades ago.

To be sure, opioid drugs are an important tool for controlling pain, but they used to only be used for the most severe pain. Better controls on prescription opioid painkillers, more holistic methods of pain treatment, patients who are more aware of the hazards of opioid painkiller usage, more widespread takeback programs, and more effective prescription drug monitoring programs would all go a long way toward reducing opioid dependencies. Legislative restrictions on law enforcement agencies trying to rein in illegal distribution of painkillers also have to be reversed. 

4. Law Enforcement and Medical Response: When access to prescription opioids is tightened, substance-dependent people quickly turn to illegal drugs, including heroin, which is increasingly laced with the deadly drug fentanyl. These are even more dangerous due to their unpredictable composition and strength. Thus, without a smarter commitment of both soft and hard power against both prescription and non-prescription opioids, we will simply never solve this problem.

The dealer who is not a user—who looks his victim coldly in the eye and peddles what could easily be a person’s last high—should be deeply criminalized.

There are three types of people in this arena. First are the users who are not  pushers. We should use pre-arrest programs, such as drug courts, to bring these people into treatment, rather than criminalizing them. Users who become dealers simply to support their addictions present especially tough cases. They require both criminal punishment and addiction treatment.

The dealer who is not a user—who looks his victim coldly in the eye and peddles what could easily be a person’s last high—should be deeply criminalized, meriting felony charges and harsh penalties. What rational society would stand for heroin and other drugs being sold literally in open markets in our cities, and even inside our schools? Unfortunately, our aversion to an overloaded justice system and overcrowded prisons, along with a societal inclination to not view drug dealing as a “violent crime”—just try telling that to a victim’s family!— severely inhibits our willingness to sweep pushers off our streets.

We should also not lose sight of the fact that most fentanyl is easily imported from China. Even though that nation is making some effort toward reining in fentanyl production and export, far more diplomatic and economic power should be applied to shutting this deadly drug off completely.

Safe use programs are a first step towards eliminating fatal overdoses and a great entry point into treatment for those caught in addiction’s deadly grip.

Finally, while safe use programs are highly controversial among Americans, other nations have demonstrated the effectiveness of these sites.  They are a first step towards eliminating fatal overdoses (due to the presence of health care professionals who can administer overdose-reversing medication) and a great entry point into treatment for those who are caught in addiction’s deadly grip. They are worthy of at least experimentation in this country.

5. Treatment and Recovery: Hard power has to be complemented by the soft power represented by getting those suffering with substance use disorder into, through, and beyond treatment programs.

A just society would address the high cost of quality treatment programs and make them available to everyone, but there simply isn’t enough capacity to get the job done. Nor is there the right capability; the nation should fully explore best practices and inculcate them into rigorous standards of care for treatment programs.

Insurance companies need to understand that paying for more than 30 days of treatment will actually cost less than paying for the effects of relapses down the road. As a society, we need to get over the notion that medication-assisted treatment (MAT) is merely substituting one drug for another.  Rather, MAT is emerging as the most important element in treatment, and should be considered the same way insulin is for diabetes: the drug that supports a lifestyle change.

We should also foster “warm handoffs” from those responding to an overdose (using the overdose-reversing drug naloxone) to those who can provide medication-assisted treatment (beginning with variants of the craving-reducing drug buprenorphine). Similarly, we need effective and ethical mechanisms for linking those seeking treatment to vetted treatment facilities.

6. Family Outreach & Support: We need to do more for families struggling with the disease of substance use disorder. This is about “if I only knew then what I know now.”

There is so much families can do to support each other, and we need to get lessons learned and best practices out any way we can.

There is so much families can do to support each other, and we need to get lessons learned and best practices out any way we can. If and when the problem occurs, there is a great deal of support available to those who are trying to get their loved one into and through a recovery process, and we need to do a better job of linking them together.

The dimensions of the solution to the opioid epidemic are so intertwined that if we ignore one of the above threads, the whole effort falls apart. If we don’t uplift prevention, more people will unwittingly drift into addiction. If we only clean up prescription drugs, then even more people will move to heroin. If we clean up both, but don’t provide treatment programs, desperate individuals will find cooperative drug dealers and other drugs. If we don’t eliminate the stigma of addiction, fewer people will seek treatment. And if we don’t raise public awareness of the urgency of this problem, all these solutions will continue to languish.

Further, all six of these lines of operation must feed into concerted, multi-vector efforts to create safe communities and safe campuses. Communities and campuses can stand up to fight this epidemic, but they need expertise, ideas, and resources if they are to succeed.

Make no mistake: this is a national emergency, not merely a public health crisis. It’s time to move beyond talk and into bipartisan action to defeat this clear and present danger to our nation with renewed public understanding, clearly defined structure, unified effort, enhanced authorities, and far more dedicated resources.

Adm. James A. “Sandy” Winnefeld, Jr., retired in 2015 after serving as the ninth Vice Chairman of the Joint Chiefs of Staff. He and his wife, Mary, founded S.A.F.E. Project US in November 2017 after their 19-year-old son died from opioid use. To learn more, visit SAFEProject.us or follow @SAFEProjectUS

Opioid Watch invites guest commentaries from readers who submit thoughtful and informed essays about how to combat the crisis; about “what works” and “what doesn’t” in terms of treatment and recovery; and other pertinent topics. If you have an original manuscript that you’d like to be considered, please submit to [email protected]. We cannot guarantee publication or even responses to every submission. Commentaries do not necessarily represent the views of Opioid Watch.