The DEA Needs To Do More, Not Less, To Combat Opioid Abuse | Opinion

The U.S. Drug Enforcement Administration (DEA) is facing fresh scrutiny about its efforts to reduce the supply of prescription opioids. Critics of the agency claim it has been overzealous in pursuit of its mission to enforce the controlled substances laws of the United States. Their complaints center on DEA's attempt to crack down on medical providers accused of misprescribing opioids and the agency's cuts to annual production quotas for the most commonly abused prescription opioids.

These criticisms have generated a lot of attention, but policymakers and the public should not rush to judgment.

In the first instance, critics have attacked DEA's use of Immediate Suspension Orders, or ISOs, an administrative tool used to remove the license of a medical provider deemed to pose an imminent danger to public health and safety. These actions are rare and reserved for the most egregious cases where there is a "substantial likelihood of an immediate threat that death, serious bodily harm, or abuse of a controlled substance will occur in the absence of an immediate suspension of registration."

The administrative record for these cases is not publicly available, but they are often quite lengthy and involve significant red flags of abuse or diversion—for example, prescribing dangerously high doses or combinations of drugs, servicing a large percentage of out-of-state patients, accepting cash payments, failing to perform basic medical assessments, and poor record-keeping. Before DEA can revoke a practitioner's license, these violations are subjected to a robust legal review and independently confirmed by expert medical professionals.

Considering DEA oversees more than 2 million retail-level registrants, which includes doctors and pharmacies, the number of ISOs it issues every year is almost negligible—in 2017 it issued only six. In fact, DEA has been criticized for not exercising this authority enough. According to the Department of Justice's Office of the Inspector General, from 2013 to 2017, "DEA significantly reduced its use of its strongest enforcement tool, the Immediate Suspension Order, to stop registrants from diverting prescription drugs." And while some of these orders are overturned through the appeals process, this represents an even smaller subset of the relatively few cases brought in the first place.

Then there's the issue of aggregate production quotas. Each year, DEA—in close consultation with the U.S. Food and Drug Administration—establishes drug production quotas for drug manufacturers based on the legitimate medical, scientific, and research needs of the country. Since 2016, DEA has consistently reduced the supply of the most commonly abused prescription opioids, including oxycodone, hydrocodone, fentanyl, hydromorphone, and morphine, in large part due to shifting views of opioids and more conservative prescribing.

Illicitly manufactured fentanyl, a drug more than 50 times more potent than heroin, has recently supplanted prescription opioids and heroin as the most significant drug threat to the United States. However, the U.S. remains the world's largest consumer of prescription opioids by a considerable margin. More than 13,000 Americans died from prescription opioids in the last 12 months alone. U.S. authorities should continue to monitor legitimate drug supplies and adjust production quotas to prevent or alleviate any potential shortages. But with the U.S. drug crisis reaching unprecedented levels, and many opioid use disorders starting with prescription drugs, now is not the time to increase their availability.

Stories of patients committing suicide after losing access to prescription opioids are indeed tragic, and federal, state, and local authorities must do more to address the elevated risk of overdoses and ensure continuation of care for those impacted by disruptions to treatment. The Centers for Disease Control, for example, should expand its Opioid Rapid Response Program‌‌, an interagency effort to mitigate overdose risks and other adverse outcomes among patients who lose access to prescription opioids. While not a panacea—the overall shortage of addiction specialists remains a serious barrier to effective treatment—the program provides a roadmap to assist patients struggling with opioid dependency or withdrawal.

But these isolated incidents, however tragic, should not be used to upend otherwise sound drug policies designed to protect the American public from drug addiction and abuse. It's important to recall that more than 108,000 Americans died from drug overdose deaths last year, primarily due to an oversupply of opioids. The U.S. is making slow but steady progress in rolling back the opioid crisis, but there is much work to be done. The threat of prescription opioids still looms large and requires continued vigilance from DEA and its partners to protect Americans' health and safety. We should be asking them to do more, not less.

Jim Crotty is the former deputy chief of staff at the U.S. Drug Enforcement Administration.

The views expressed in this article are the writer's own.