Federal scientists warned of next opioid crisis in 2006

According to a confidential document obtained by POLITICO, two of the government's top scientists detected the first signs of the emerging opioid crisis in 2006 and tried to warn health officials and the public of the upcoming disaster.

The effort did not result in any real action and the toll of death and dependence increased. Since then, more than 133,000 people have died from prescription opioids and hundreds of thousands of other illicit drugs, including heroin and fentanyl, an illicit product.

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Scientists' note of 15 March 2006, obtained under the Freedom of Information Act, shows that directors of the National Institute on Substance Abuse and the National Institutes of Health report "disturbing" data showing a dramatic increase in opioid addiction, including among adolescents. – and asked for urgent action. Agency managers then wanted to go to the United States. Surgeon General Richard Carmona will inform the public of the dangers of prescription drug abuse.

The note from NIDA's director, Nora Volkow, led Carmona to agree to launch a formal call for action – the most urgent and powerful tool available to its office – to capture the public's attention and raise public awareness of emerging public health issues. Similar calls have been used to combat threats, including tobacco, and to urge the public to wear seatbelts.

"Given the startling statistics, raising awareness of this issue should be a top priority for public health," Volkow wrote. But the action that she had initially triggered with the memo has faded over the months, while health agencies were focusing on other issues. Public health officials, including those working in the field of addiction and mental health, did not fully understand the magnitude of the problem.

Instead, an emerging crisis exploded – metastases from overconsumption of legally prescribed drugs in illicit pill mills and black markets for these drugs, as well as heroin, a cheaper and sometimes opioid easier to obtain. Then came fentanyl, a powerful synthetic opioid that has been the cause of overdose spikes in recent years.

Carmona told POLITICO during a phone interview this week that staff from different health agencies had come together to lay the groundwork. He has had a number of meetings to discuss the call for action with officials from the office of former Secretary of Health Mike Leavitt, where the current secretary at the President Donald Trump's health and social services, Alex Azar, was a deputy at the time, as well as President George W. Bush. Internal Policy Council of the House. But Carmona's mandate ended a few months after Volkow sent his memo. An Acting Surgeon General took over. The little momentum built for a public warning evaporated. Azar's office declined to comment and Leavitt did not respond to requests for comment.

If the call to action had been successful, it was the federal government's first major attempt to counter the aggressive marketing of pharmaceutical companies that had led doctors to prescribe painkillers liberally – too liberal, retrospectively.

The other problems ended up setting a precedent. Some public health officials at the time said the methamphetamine epidemic swept through rural America.

"We were facing global health, national readiness after September 11, for bioterrorism," said Carmona, adding that his goal, as a general surgeon, was also to address the epidemic of obesity in the country. "The crisis was in its infancy. It was not like we had dropped the ball, "said Carmona, adding that the Volkow memo signaled the first signs of problems, but that health officials did not have the type of granular data which currently exists.

Volkow's note to Carmona, however, included a number of statistics extracted from federal data showing signs of the nascent crisis, noting in particular an increase in the abuse of oxyxyne, vicodine and other prescription drugs among high school students.

"NIDA's 2005 Future Tracking Survey found that about one in ten high school students would have abused Vicodin before graduating," Volkow wrote. "This statistic is alarming, especially if we consider that this drug is not the only prescription being the subject of abuse." She referred to a separate NIDA study according to which more than 1.6 million American adolescents and young adults had abused a prescription stimulant over a 12-month period. period and 75,000 became dependent. It also included data from the National Survey of Drug Use and Health, according to which about 6 million people in 2004 reported having currently used a prescription psychoactive drug.

"We have seen an increase in sedative and OxyContin abuse among grade 12 students as well as an alarming rate of prescription-stimulant drug abuse," she said. she writes. Former NIH director Elias Zerhouni, who is now retired, also signed the memo. He could not be reached for comment.

Volkow, a respected doctor and scientist still at the helm of NIDA, refused to be interviewed about the events of 2006, although a spokeswoman confirmed his meeting with Carmona. Although she privately and publicly spoke with officials about the plague of opioids, she did not explain whether or how she had tried to attract the attention of high level on the opioid crisis.

"I regularly brief NIH and HHS officials on trends in substance use, particularly among adolescents and young adults, who are most vulnerable to the effects of drugs, as I did at the time. 'a meeting in 2006 with Surgeon General Richard Carmona,' said Volkow. said in a statement by e-mail. "The Surgeon General was receptive to the concerns expressed at the meeting."

Geoffrey Laredo, a former Senior Advisor at NIDA who worked closely on early call for action, said that his agency's work on the project had been completed and that its wording had been verified. He was never told why the job was not going anywhere.

"As far as I know, we were finished and the language was checked, why did not it happen?" It remains a mystery to me, "said Laredo, adding that his colleagues from NIDA and him – even worked for months. The call to action was frustrated that it never materialized.

"There was absolute frustration," he said. "We were faced with what we thought was a public health crisis that needed to be addressed and we had what we thought was an agreement with the general surgeon to do something about it. We produced this thing … and then he never saw the light of day. "

The warnings issued by NIDA and the NIH in 2006 were not the only warnings to government authorities about the prescription drug crisis of the day. The New York Times reported last year that a confidential document dating from the same year told Justice Department lawyers that Purdue Pharma, the maker of OxyContin, knew the drug was causing a increase in the number of drug addicts and has taken steps to deceive the public and lawmakers. American parliament. This memo has never been made public and the charges against the drug maker have never progressed. The company is now involved in a litigation concerning opioids.

Between 2006 and 2012, about 76 billion prescription painkillers flocked to communities across the country, according to federal data recently obtained by the Washington Post by way of a court order. Many counties, concentrated in the Appalachians and in other rural communities that have received a disproportionate share of opioids, have had above average rates of overdose deaths.

In addition to the memos, government officials also had access to the addiction alert network reports of the Mental Health and Mental Health Services Branch, which showed peaks in emergency room visits related to prescription drug abuse in 2003 and 2004.

The problem was also reported in the 2006 National Strategy of the Office of National Drug Control Policy of the White House. "The abuse of prescription drugs, including OxyContin (oxycodone), has become the second most common form of drug abuse," the report says.

John Walters, director of the agency for almost the entire administration of George W. Bush, said he had never been aware of a call for money. action, but said that some kind of public message emanating from the general surgeon or the health department could have been helpful. difference.

"I can not imagine that it could have done anything but improve the situation," Walters said of the call to action. "Would it have ended the crisis? Probably not. But that would have increased awareness. More people would have known the dangers. We would have saved more lives.

Instead, the crisis deepened under the administrations of George W. Bush and Obama. According to CDC figures, more than 542,000 people died of a drug overdose between 2006 and 2017.

Walters said the Bush administration was working behind the scenes to fight prescription drug abuse, including setting up a pilot testing program and improving access to treatment and supporting prescription drug monitoring programs set up by the state to prevent physician purchases. But he acknowledged that increased public awareness would have facilitated their work.

"The real problem was raising awareness and maintaining the training and knowledge needed to perform screening and referrals," he said.

Under the Obama administration, the Bureau of National Drug Control Policy issued a strategy to combat analgesic abuse in 2011. Later in the year, CDC director Tom Frieden said the overdose of prescription painkillers were at "epidemic levels" and called on the health industry to help stop the crisis. However, the death toll continued to rise and the problem was only described as a major public health crisis a few years later.

President Barack Obama urged Congress to pass a bill to fight the epidemic in 2015 and signed two bills to expand access to treatment in 2016, his last year in office . That year, his administration published the CDC guidelines on opioid prescribing, intended to curb the liberal prescription of pain medication. She also published a report from the general surgeon on addiction, about 10 years after the initial discussions on a call for action.

Then, in the 2016 presidential election, President Donald Trump, who swept aside states like West Virginia particularly affected by drug addiction, has become a major campaign issue. Trump has made this issue a top priority for his administration and said the crisis was a public health emergency in 2017, when the number of overdose deaths peaked at 72,000.

Since 2016, Congress has passed three important laws to deal with the crisis and allocated more than $ 6 billion to states. Azar, now at the helm of HHS, has given priority to the issue and praised the administration's efforts. Preliminary data from the CDC for 2018 show that deaths appear to be slowing down, although final figures will be released later this year. Although early reports suggest a decline in the number of prescription opioids, the number of deaths related to fentanyl and other drugs, including methamphetamine and cocaine, has increased in recent years.

The subject of addiction has already become a problem in the presidential race of 2020. Democratic candidates, including Elizabeth Warren and Amy Klobuchar, have unveiled their own proposals to fight the epidemic.

To the question of whether a call for action launched 13 years ago could have changed the trajectory of the deadly crisis, Carmona disapproved.

"Would it have made a difference?" It's hard to say, I do not have a crystal ball, "he said." But I'd like to think that all communications surgeons make the difference. "