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 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.
A remarkably thorough and always sensible study.