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Senator Manchin’s Latest Attempt at Curbing Opioid Addiction Is a Very Bad Idea

Jeffrey A. Singer

Earlier this month, in an effort to help stem the nation’s
rise in opioid addiction and overdose, Sen. Joe Manchin (D-WV)
introduced a bill that purports to
solve that problem. The bill would require the Food and Drug
Administration to revoke the approval of one opioid pain medication
for each new opioid pain medication the FDA approves for health
care practitioners to prescribe.

As a practicing surgeon who prescribes pain medication for my
postoperative patients, I think the senator’s proposal will
not only make the opioid problem worse, but also create new
problems as well.

This proposal essentially caps the number of arrows I may have
in my quiver. Every patient is unique. It is not unusual for a
patient in pain to have a poor response — or even an adverse
reaction — to a pain medication that works well in most other
patients. On many occasions, I need to try on my patient several
different types of opioids, sometimes in combination with other
types of analgesics, until I get my patient relief from pain. I
need as many options as possible. Demanding the removal of one
existing option for every new option that arises hampers and
intrudes on my ability to complete my primary mission: the relief
of suffering.

Sen. Manchin’s proposal
is another example of a well-intended but inappropriate intrusion
into the practice of medicine and the patient-doctor relationship
by people who presume the ability to engineer human
behavior.

It also invites unintended consequences. Suppose a new opioid is
approved that is found to be faster acting and more effective in
relieving pain, yet has a higher potential for addiction and
respiratory depression than those already approved. Is it really a
good idea to remove from doctors’ armamentarium a less potent
and less dangerous opioid to make room for the new one?

It is not rare for a newly
approved drug, several months after its introduction into the
marketplace, to be found to have serious adverse effects not
previously demonstrated during FDA clinical trials, and then be
pulled from the market by the manufacturer or the FDA.

Suppose this happens with a new opioid that replaced an older
one under Sen. Manchin’s bill? Does the old one get
re-approved? Or is the practitioner left with even fewer
options?

Finally, if Sen. Manchin thinks that limiting the number of
opioids legally available will prevent addicts from obtaining their
opioid of choice, then maybe he hasn’t heard about the Heroin
epidemic. Heroin was banned in the US in 1924, but remains readily available and
in fact has become a popular substitute for opioid addicts who are
cut off by their prescribers and turn to the black market for
relief. In 1924, morphine was the most common intravenous drug to
which people were addicted. When heroin was totally banned, it
became much more attractive than morphine for drug dealers to
promote, because they had no competition from the legitimate
market, and soon heroin overtook morphine in sales.

Removing popular opioids from the legal market merely transfers
drug options from health care practitioners to black market drug
dealers.

Sen. Manchin’s proposal is another example of a
well-intended but inappropriate intrusion into the practice of
medicine and the patient-doctor relationship by people who presume
the ability to engineer human behavior. I appreciate the
senator’s concern, but if he is looking for an answer to the
opioid abuse problem the answer lies in “harm
reduction.” Let doctors be
doctors
. Let them exercise their professional judgment and work
with patients who have opioid dependency, confidentially and
compassionately.

If a doctor decides it is less harmful for the patient to get a
refill of the opioid prescription than to send the patient to the
street, the doctor should be able to do so.

Naloxone is an effective antidote to the respiratory depression
that arises from an opioid overdose. It is available in
intravenous, subcutaneous (like an insulin injection), and nasal
spray form. Pharmacists should be allowed to dispense naloxone
without a prescription, and naloxone should be made more readily
available to first responders. This is already happening in
some states, such as New Mexico.

If Senator Manchin really wants to help solve the problem, he
should stop doubling down on the same strategy that has failed us
since the 1920s and try something new.

Jeffrey A.
Singer

practices general surgery in Phoenix, AZ and is an adjunct
scholar at the Cato Institute.