opioids, is expanding rapidly in scope and sophistication. Supply reduction must extend from global strategies to strategies in neighborhoods throughout the country. Importantly, the drug policy choice


for the future is not a choice between law enforcement and treatment.30


Instead


it is the integration of law enforcement and health care, including prevention, to achieve the public health goals that neither can achieve alone. It is commonly said that the nation cannot arrest its way out of the overdose epidemic. Tat is true and important. However, it is also true and important, but seldom stated, that the nation cannot simply treat its way out of the overdose epidemic. Te criminal justice system is central to an improved drug policy with a key focus on more effectively managing the estimated 4.6 million Americans on parole and probation, many of whom are addicted to alcohol and other drugs, including opioids.31 Tankfully there are many encouraging


developments and a remarkable new bipartisan national resolve to focus as never before on reducing the tragic drug overdose death epidemic. Where we are today is the only the beginning of the much-needed new policies and practices to achieve this goal.32


3


References 1


Drug Enforcement Administration. (2016, November). 2016 National Drug Threat Assessment Summary. DEA-DCT- DIR-001-17. Washington, DC: US Department of Justice. Available: https://www.dea.gov/resource-center/2016%20 NDTA%20Summary.pdf


2


Hughes, A., Williams, M. R., Lipari, R. N., Bose, J., Copello, E. A. P., & Kroutil, L. A. (2016, September). Prescription drug use and misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. Available: https://www. samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/ NSDUH-FFR2-2015.htm


Paulozzi, L. J., Mack, K. A., & Hockenberry, J .M. (2014). Vital signs: variation among states in prescribing of opioid pain relievers and benzodiazepines—United States, 2012. Morbidity and Mortality Weekly Report, 63,563-568. Available: https://www.cdc.gov/mmwr/preview/mmwrhtml/ mm6326a2.htm


4


Dowell, D., Haegerich, T. M., & Chou, R. (2016, March 18). CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016. Morbidity and Mortality Weekly Report, 65(1), 1-49. Available: https://www.cdc.gov/ mmwr/volumes/65/rr/rr6501e1.htm


5


Hedegaard, M., Warner, M., & Minino, A. M. (2017, December). Overdose deaths in the United States, 1999– 2016. NCHS Data Brief, 294. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Available: https://www.cdc.gov/nchs/data/databriefs/db294.pdf


6


Substance Abuse and Mental Health Services Administration. (2017). Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Table 5.2A. Available: https://www.samhsa.gov/data/ sites/default/files/NSDUH-DetTabs-2016/NSDUH- DetTabs-2016.pdf


7


Katz, J. (2017, April 14). You draw it: just how bad is the drug overdose epidemic? The New York Times. Available: https://www.nytimes.com/interactive/2017/04/14/upshot/ drug-overdose-epidemic-you-draw-it.html


8 9 Ibid. Tose future policies


and practices depend on our accurately understanding the current opioid epidemic, how it happened and what needs to be done to turn it back. It is to facilitate that vitally important understanding that is why this new narrative was writen. ❚


Robert L. DuPont, MD is President of the Institute for Behavior and Health, Inc. He served as the first Director of the National Institute on Drug Abuse and second White


House Drug Chief. This article was published in the Winter 2018 issue of The Journal of Global Drug Policy and Practice, http://www.globaldrugpolicy.org/.


Remarks by President Trump on combatting drug demand and the opioid crisis. (2017, October 26). Available: https:// www.whitehouse.gov/briefings-statements/remarks- president-trump-combatting-drug-demand-opioid-crisis/


10


Higham, S., & Bernstein, L. (2017, October 15). The drug industry’s triumph over the DEA. The Washington Post. Available: https://www.washingtonpost.com/ graphics/2017/investigations/dea-drug-industry-congress/


11


Whitaker, B. (2017, October 15). Ex-DEA agent: opioid overdoses fueled by drug industry and Congress. 60 Minutes, CBS News. https://www.cbsnews.com/news/ex-dea-agent- opioid-crisis-fueled-by-drug-industry-and-congress/


12


Florida Drug-Related Outcomes Surveillance and Tracking System (FROST), http://frost.med.ufl.edu/


13


Cicero, T. J., Ellis, M. S., & Kasper, Z. A. (2017). Psychoactive substance use prior to the development of iatrogenic opioid abuse: a descriptive analysis of treatment- seeking opioid abusers. Addictive Behaviors, 65, 242–244.


14


Muhuri, P. K., Gfroerer, J. C., & Davies, C. (2013). Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Review. Available: http://archive.samhsa.gov/data/2k13/ DataReview/DR006/nonmedical-pain-reliever-use-2013.pdf


15


Substance Abuse and Mental Health Services Administration. (2017). Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Table 6.53B. Available: https://www.samhsa.gov/data/sites/default/files/NSDUH- DetTabs-2016/NSDUH-DetTabs-2016.pdf


16


Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain—misconceptions and mitigation strategies. New


30 27 17


England Journal of Medicine, 374, 1253-1263. Available: http://www.nejm.org/doi/full/10.1056/NEJMra1507771


Chou, R., Deyo, R., Devine, B/, Hansen, R., Sullivan, S., & Jarvik, J. (2014). The effectiveness and risks of long- term opioid treatment of chronic pain: Evidence Report/ Technology Assessment. No. 218 (AHRQ publication no. 14-E005-EF). Rockville, MD: Agency for Healthcare Research and Quality.


18


Cicero, T. J., Ellis, M. S., & Kasper, Z. A. (2017). Psychoactive substance use prior to the development of iatrogenic opioid abuse: a descriptive analysis of treatment- seeking opioid abusers. Addictive Behaviors, 65, 242–244.


19


National Institute on Drug Abuse. (2014). Drugs, Brains, and Behavior: The Science of Addiction. NIH Pub No. 14-5605. Rockville, MD: NIDA. Available: https://www. drugabuse.gov/publications/drugs-brains-behavior- science-addiction/drug-abuse-addiction


20


DuPont, R. L. (2017, October 23). For a healthy brain teens make “One Choice.” Rockville, MD: Institute for Behavior and Health, Inc. Available: https://www.preventteendruguse. org/s/IBH_Commentay_One_Choice_10-23-17.pdf


21


DuPont, R. L. (2017). The opioid epidemic is an historic opportunity to improve both prevention and treatment. Brain Research Bulletin, pii:S0361–9230(17), 30292-3097.


22


Madras, B. K. (2017). The surge of opioid use, addiction, and overdoses: responsibility and response of the US health care system. JAMA Psychiatry, 74(5), 441- 442. Available: https://jamanetwork.com/journals/ jamapsychiatry/fullarticle/2612443


23


Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain: United States, 2016. JAMA, 315(15), 1624-1645. Available: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm


24


Florida Drug-Related Outcomes Surveillance and Tracking System (FROST), http://frost.med.ufl.edu/


25


Reaney, P. (2014, February 28). Philip Seymour Hoffman died of accidental overdose: official. Reuters. Available: http://www.reuters.com/article/us-philipseymourhoffman- autopsy-idUSBREA1R1X920140228


26


Hedegaard, M., Warner, M., & Minino, A. M. (2017, December). Overdose deaths in the United States, 1999- 2016. NCHS Data Brief, 294. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Available: https://www.cdc.gov/nchs/data/databriefs/db294.pdf


See, e.g., U.S. Department of Justice, Drug Enforcement Administration. (2017). 2017 National Drug Threat. DEA- DCT-DIR-040-17. Washington, DC: DEA. Available: https:// www.dea.gov/docs/DIR-040-17_2017-NDTA.pdf


28


DuPont, R. L. (2017). The opioid epidemic is an historic opportunity to improve both prevention and treatment. Brain Research Bulletin, pii:S0361–9230(17), 30292-3097


29


Centers for Disease Control and Prevention. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. Morbidity and Mortality Weekly Report, 65(1), 1-49. Available: https://www.cdc.gov/mmwr/ volumes/65/rr/rr6501e1.htm


DuPont, R. L. & Humphreys, K. (2011). A new paradigm for long-term recovery. Substance Abuse, 32(1), 1–6.


31


Kilmer, B., Caulkins, J. P., DuPont, R. L., & Humphreys, K. (in press). A large and promising opportunity: reducing substance use in criminal justice populations. In: S.C. Miller, D.A. Fiellin, R. N. Rosenthal, & R. Saitz (Eds.) The ASAM Principles of Addiction Medicine (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.


32


The President’s Commission on Combatting Drug Addiction and the Opioid Crisis. (2017). Final Draft Report. Available: https://www.whitehouse.gov/sites/whitehouse. gov/files/images/Final_Report_Draft_11-15-2017.pdf


www.datia.org


datia focus


13


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52