THE UNITED STATES OF OPIOIDS

Health care attorney Nelson (From
ObamaCare to TrumpCare, 2017) provides an in-depth historical and
analytical overview of the opioid crisis in America and suggests wide-ranging
solutions.

For decades, the United States has
been ravaged by opioid addiction—a problem that’s escalated to epidemic
proportions. Nelson traces its historical arc from the late 19th century through
the passage of significant legislation, such as the Harrison Narcotics Tax Act
in 1914, and the creation of the Drug Enforcement Administration in 1973. The
author goes on to present a synoptic account of the problem’s growth in the
1990s, when OxyContin and fentanyl became the most popular opioids, and of how inadequate
responses from law enforcement, physicians, and the pharmacological industry
only exacerbated the crisis. The author asserts that a new emphasis on the
treatment of pain, dubbed the “fifth vital sign,” contributed to systemic
failures into the present day, as did the insurance industry’s preference for
cheaper (though more addictive) drugs and a woeful lack of knowledge and
training on the parts of physicians. Nelson also lays blame on what he sees as an
overall moral diminishment in America: “We cannot fully address the opioid
crisis without seeking to understand this broader crisis of human suffering—the
byproduct of a culture of chronic stress, trauma, and increasing isolation as a
result of technology and the erosion of social support in our communities.” The
author insightfully articulates a plan of reform—“seven pillars” of public
health that include establishing outreach and prevention programs, providing
more access to addiction treatment, and developing stronger law enforcement
responses to the opioid black market. Nelson has a quarter-century of
experience as a health care lawyer, and his extraordinary expertise in on full
display here. Over the course of his book, he refreshingly furnishes a
kaleidoscopic account of the many causes of the opioid crisis rather than launching
a political jeremiad that demonizes a particular group. Along the way, he
consistently delves into complex matters with sensitivity. This tendency is
particularly evident in his discussion of the virtues and vices of cannabis.