As a clinician and a person in long-term recovery, I have been involved in this “War on Drugs.” Those of us in the trenches see the ongoing tragedy first hand, and it can definitely feel like we are losing the “war.” On most days I work with individuals who are struggling with active addiction and assist them in obtaining the best level of treatment. In many cases, these individuals have other co-occurring mental health disorders or ongoing medical issues. I also receive daily phone calls, e-mails and text messages from family and friends who deeply care about their addicted loved ones, but are unable to tolerate the behavior that always is present with an individual suffering from active addiction. Addiction is not a victimless crime–it takes hostages and also creates ruin, estrangement and forced detachment from loved ones for the family’s own survival.
For the thousands of dedicated treatment professionals, interventionists, recovery coaches, and recovering men and women, the work can leave them fatigued, overwhelmed, and concerned that the work will be never ending. They continue to debate which treatment is most effective, whether abstinence or moderation is the best approach, and whether addiction is a disease or a social malady. In the past, the prospective theoretical camps circled the wagons, while teens and adults died.
The current strategies of addressing alcoholism and addiction are ineffective, expensive, and outdated. The current national health problem pertaining to Opioid Dependence is at an epidemic level. More than 120 people overdose and die each day, and this disorder does not discriminate and affects all races, cultures, genders, ages, and socioeconomic statuses. This is a public health crisis that impacts one in three Americans.
Here is some history:
In the 1990s, opioid prescriptions in the United States began to rise. Pharmaceutical manufacturers were releasing new and potent painkillers such as OxyContin, and medical doctors were told that pain was being undertreated. As prescriptions rose across the country in the 2000s, opioids became a recreational drug for many. By the time individual states began to crack down on physicians who easily gave out prescriptions, the epidemic was already in full swing.
In many states, there are now tighter restrictions on prescription opioids and increases in treatment options, but the epidemic is still a problem on a national and even global scale. There are over 23 million Americans who are in recovery from alcohol and drugs and approximately 21 million Americans who are currently abusing alcohol and both legal and illegal substances. An estimated 2 million people in the United States have a substance use disorder related to prescription painkillers, and almost half a million people struggle with a heroin addition. Deaths due to overdose have also tripled in the past 20 years.
Confronting a problem that impacts the country on such a huge scale remains a challenge. To start, people often do need opioid painkillers when they experience extreme pain, but health professionals must consider how they can relieve pain but also reduce the risk of addiction. The public must also consider how to address the recreational use of opioids, especially among young people, and hold pharmaceutical companies responsible for their aggressive marketing. Though opioid prescriptions dispensed in the US have dipped slightly in the past few years, they are still alarmingly high.
Opioids are the most addictive when they are used in a manner that enhances the “high” experienced by the user, such as injecting, snorting crushed pills, or using pills with other drugs or alcohol. People may resort to these methods because they have developed a tolerance for the drug, which means a person requires a higher dose of the medication to achieve the same effect. People are at risk for addiction when they do not take the medication as prescribed, and experts warn that for some people, it’s possible to become addicted even when taking the prescribed amount. This is why it’s imperative to consult with your doctor frequently when you have a prescription for an opioid painkiller.
When tolerance to the drug increases or when a person is unable to obtain more of a painkiller, he or she may switch from prescription opioids to heroin. Heroin is often cheaper and easier to locate than prescription drugs, and as a result, heroin use in the United States has more than doubled since 2005. Previously a problem in urban areas, heroin addiction has extended its reach into many small towns and rural areas. Among its many dangers, heroin use puts people at high risk of overdose or contracting HIV or other diseases via intravenous injection.
In 2016, multiple efforts are underway to address the epidemic. Researchers are working to develop non-opioid medications, and they have already created new medications to fight overdose. Medications such as methadone, naltrexone, and buprenorphine can play a vital role in treating opioid addiction and helping someone reestablishing control over their life. Medication has specifically proven more effective when given in conjunction with behavioral interventions such as therapy.
Perhaps the most fundamental component to curbing opioid abuse is educating the public about the dangers of abusing prescription opioids. Physicians, medical students, and other healthcare professionals should know and recognize the behaviors associated with prescription opioid abuse, but anyone in need of pain medication or at risk for substance abuse should be educated about the risks and signs. If you or a loved one is dependent upon prescription painkillers, ask for help today. Treatment is available, and it is possible to live a life free from the grasp of opioids.
From my perspective, the United States has perpetuated a practice that encourages people to seek immediate medical intervention for any type of pain, as over 80% of all physician visits are for some sort of pain relief. Doctors are then tasked with assisting their patients, usually with pharmaceutical intervention, and these interventions are usually with prescriptions for opiates. As we know, the pharmaceutical industry is a big profit driven business and medical professionals are encouraged to prescribe.
Only approximately 10% of the estimated 21 million who meet the care for an alcohol or substance use disorder reach treatment, and much of this care does not meet the criteria for successful evidenced based practices. There are over 2,000 residential treatment facilities in the U.S., but many individuals struggle with a lack of access to care because they lack private insurance. In addition, the number of residential treatment facilities that are supported by state and federal Funding is declining while the need is increasing.
A major objective was reached on March 14, 2016, when the American Board of Medical Specialties (ABMS) formally announced recognition of the field of Addiction Medicine as a medical subspecialty. This is a advance with great symbolic and viable implications for health care and for those affected by drug and alcohol use disorders, including nicotine addiction. It signals the legitimacy of Addiction Medicine as a field of specialized study and practice, and it will enable the accreditation and expansion of Addiction Medicine training programs. Up until now, none of the 9,500 accredited U.S. graduate medical education residency programs have had training programs in Addiction Medicine, and historically these residents would have minimum training in addiction.
A major overhaul is necessary to change the way addiction is viewed and this work must be addressed in public and social media, public health, the private industry and at the local, state and federal levels of government. This effort needs to be consistent and relevant to the present day problems, with “out of the box” solutions. There must be ongoing thought-provoking and solution-focused conversations to address this public health crisis.