Thank God I retired years ago. One of the legs of President Trump's plan to solve the opioid crisis is to institute the death penalty for drug dealers. Pharmacists deal with and dispense narcotic prescriptions to alleviate pain, on a daily basis. Stories abound of patients becoming addicted because of usage. The president's edict would have caused me to worry that I might become a target for the death penalty if one of my patients died from an overdose. Does this encapsulate the president's thinking as well?
The president's proposal presents another challenge to the neighborhood pharmacist's practice. Pharmacies are often the target for desperate individuals and criminals in pursuit of drugs. During one particularly difficult time in my practice, I found myself confronted by two armed robberies and two burglaries within a six-month period. I recall that after one such burglary, I found myself facing a robber with a gun pointed at me two days later. Having had no time to restock supplies from my loss of stolen narcotics, my first thought was that I was a dead man. I told the gunman that I would be glad to give him whatever he wanted (he came with a shopping list), but that I had just been cleaned out, although luckily a few items on his list had been overlooked by the burglar. It was a scary moment. I feared for my life then, while over the next six months I felt paranoid because of those events. At one point, I called the police because a customer walked into my pharmacy after dark with a shopping bag, fearing it contained a weapon, but happily it did not. Do pharmacists now have to fear for their lives because of a presidential edict?
President Trump appears to have derived his inspiration for implementing the death penalty to deal with drug dealers because of his admiration for President Rodrigo Duterte of the Philippines. Mr. Duterte is a 71 year-old democratically elected president who is a populist with authoritarian tendencies. Sound familiar? Duterte's war on drugs against drug dealers and drug users has resulted in extrajudicial killings of more than 12,000 citizens, more than 4,000 by police and the remainder by "unidentified gunmen." Most victims came from poor families in urban centers across the country. Critics of Mr. Duterte's anti-drug campaign are routinely impugned, criticized, harassed and threatened, tactics that President Trump understands, many of which he has used numerous times. Is this what the president has in mind?
We all know that Mr. Trump has a brilliant mind. He's also very smart. Actually, the smartest, as he so modestly has stated. And with the best brain on the planet, or so he says. But clearly execution can't possibly be the best solution for solving the problem of the opioid epidemic. In the 80's and 90's we filled our prisons with persons who were selling and/or using drugs. At least one in five people of the 2.3 million imprisoned in various federal, state and local detention facilities in 2017 was there for a drug offense, according to the Prison Policy Initiative. This includes nearly half of all those incarcerated at the federal level. As of year end 2015, about 197,200 prisoners (15%) in state confinement were convicted of a drug related offense as their most serious crime. In the most recent report, as of September 30, 2016, 56% of all women (7,600) in federal prisons were serving sentences for drug offenses, compared to 47% of males (75,600). Does anyone seriously believe that selling drugs should be a capital offense? Would the punishment fit the crime? But on the other hand, it is one way to limit the prison population.
Maybe Tom Lehrer, the former Harvard math professor and song writer, should start shaking in his boots because of a song he wrote entitled 'The Old Dope Peddler.' Trump may be out to get him next because of the lyrics: "It's the old dope peddler spreading joy wherever he goes. He gives the kids free samples, because he knows full well, that today's young innocent faces will be tomorrow's clientele." Better beware, Tom Lehrer.
Another leg of the Trump's three-legged stool opioid crisis solution is a provision for E.R. overdose addicts to be provided with Naloxone (Narcan) upon being released from the E.R. I agree with this idea wholeheartedly. Naloxone will save lives because when an addict overdoses, this drug will nullify the effects that otherwise might result in death.
The third leg of Trump's proposal is to reduce the available prescription opioid drugs available to wholesalers by manufacturers to be distributed to pharmacies by 33% within three years. I find such a "solution" hugely problematic. Patients in community pharmacies are already having difficulties obtaining their prescriptions due to limitations in supply of narcotic drugs imposed by the government and in turn by distributors upon those pharmacies. I know of one case recently where the patient was in severe pain from having broken his leg in four places because of a bike accident and had to go to five different pharmacies before finding one that could fill his opioid prescription because pharmacies were all out. It was near the end of the month and they had already used up their monthly allotment. I also am aware of a local medical building pharmacy which has a pain management clinic in that building. The pharmacist no longer accepts new patients because he can barely supply his current patients with their pain medication needs.
The situation is no better in hospitals. There is a shortage of numerous injectable narcotic medications, including but not necessarily limited to morphine, fentanyl and Dilaudid at many hospitals and surgical centers around the country. The cause is linked both to problems in manufacturing as well as the government's effort to restrict drug production. The situation is more severe in some areas than others. At some centers, elective surgeries such as gall bladder removal and hernia repair have had to be postponed. Pharmacists, doctors and nurses in consultation have had to change their drug formulary and protocols as far as drug use for certain patient conditions because of the shortage. Often this has resulted in patients being given less effective medications to control their pain levels. The situation has increased the likelihood of errors in calculating workarounds in dosing patients, in some cases it has been life threatening.
All in all, the restriction of the manufacture and distribution of opioid/narcotic drugs by the government has already put a strain on the system. To further reduce the availability of these important chemotherapeutic agents would not only further exacerbate the situation, but also would be totally unwise, causing harm to the patient. Making naloxone available to addicts makes sense, just as a clean needle program does. Implementing the death penalty for drug dealers is inhumane and may be illegal. Additional policy components may be added, but as always, will there be sufficient funding for those programs? I am sure that knowledgeable professionals could come up with better choices. However, that doesn't seem to be the way this administration operates.