• Treating the Opioid Epidemic

    The overuse use of opioids has become a national crisis.

    The user’s descent into pain, addition, and sometimes death often begins with physical pain, treated by prescription medicine. The patient can become addicted to the prescribed opioids, only to find they provide less and less relief or that the prescriptions run out. At that point, they turn to under-the-counter meds and sometimes move on to heroin. This descent often ends in medical emergencies and, if the addict cannot break the tenacious habit, it ends in death.
    The numbers are staggering. 2.6 million Americans are hooked on opioids such as oxycodone, fentanyl, and heroin.

    Fatalities, around 8,000 in 1999, are now over 33,000, according to the Center for Disease Control.

    A valuable, brief article in the Wall Street Journal discusses the way forward. The author, Dr. Sally Satel, is scholar-physician who treats addicts and studies the epidemic.

    Dr. Satel makes several important points:

    • Treatment is far better than punishment
    • The “medicalized rhetoric” of the public-health establishment oversimplifies the problem since the problem is more than a “brain disease”
    • Because the problem is more complex, simply prescribing anti-addiction medications will not solve it
      • Many patients use opioids even while using the anti-addiction meds
      • Others drop out of the anti-addiction med programs
      • The anti-addiction medications are subject to abuse themselves
    • More effective solutions require supervision to ensure the patient actually takes the anti-addiction medication and receives support through the difficult withdrawal process.
    • The supervision may need to be involuntary, mandated by courts, for some patients

    The problem is widespread, deadly, and hard to solve. Dr. Satel’s explanation and suggested approach makes her article well worth reading.

     

  • Worth reading: Eliot Cohen, “When Pres. Trump Goes to War”

    Eliot Cohen is one of the country’s leading strategic thinkers, with deep experience advising the government and senior military officials.

    His thoughts on how Pres. Trump might use force or threats are well worth pondering.

    Here’s his piece in the Wall Street Journal:

    Eliot Cohen: When President Trump Goes to War (link here)
    A new commander in chief will soon face hard decisions about how and when to deploy America’s military might. What principles should guide him?

    Here is the heart of Cohen’s judgment:

    First, the United States should not commit forces to combat overseas unless the particular engagement or occasion is deemed vital to our national interest or that of our allies.

    Second, if we decide it is necessary to put combat troops into a given situation, we should do so wholeheartedly, and with the clear intention of winning.

    Third, if we do decide to commit forces to combat overseas, we should have clearly defined political and military objectives. And we should know precisely how our forces can accomplish those clearly defined objectives. And we should have and send the forces needed to do just that.

    Fourth, the relationship between our objectives and the forces we have committed…must be continually reassessed and adjusted if necessary.

    Fifth, before the U.S. commits combat forces abroad, there must be some reasonable assurance that we will have the support of the American people and their elected representatives in Congress.

    Finally, the commitment of U.S. forces to combat should be a last resort. –Eliot Cohen, opinion essay, Wall Street Journal