Opiate abuse is the crisis du jour in the medical and psychiatric world. I’ve seen reference to it in the psychiatric journals, in the New York Times, and in the Summer, 2017 issue of Utne magazine. There are Continuing Medical Education credits available for it.
Do I believe opiate abuse is a new problem, or that it has suddenly grown into the gigantic epidemic the “authorities” claim? I know there is a push for funding for substance abuse treatment. Other than that, I believe the “crisis” is fueled by enablers who need to be needed.
First, the literature I read makes no distinction between heroin, which is an absolutely illegal drug in the US, and the other opiates. There’s a vague claim that the heroin is coming in from Mexico, but I wonder if it’s coming home with troops from Afghanistan, too. No one has asked that question.
The legal-with-a-prescription opiates are presumed to be used for pain, and apparently there is a growing trend to abuse prescription opiates. Doctors who prescribe too many of them fall under the DEA’s watchful eye, so I wonder how many doctors are willing to risk their licenses to support an abuse habit. There are pain clinics sprouting up around the country, specialty clinics in which opiate use is standard. These are carefully monitored by the DEA, as are pharmacy records that show which docs are prescribing controlled substances.
A large number and variety of substance abuse treatment methods and facilities exist, but effectiveness over the long term is poor. Most studies into substance abuse treatment only follow patients for a year. Long term studies are rare. Alcoholics Anonymous (AA) and its spin-offs, like Narcotics Anonymous and Cocaine Anonymous—with their reliance on the 12-Step Program—have remained the standard since 1935. These are free programs, peer supported, in which names and paperwork are not required.
My questions about this new “crisis” stems from my cynicism about our current drug-centered world. The difference between “good” drugs and “bad” drugs is only a matter of legality, according to me. Drug laws confuse the issue and create problems that needn’t exist. Even the Psychiatric Times is beginning to take a fresh look at substances such as marijuana, looking to explore its potentially therapeutic effects. There was a recent article suggesting hallucinogens like LSD and psilocybin might deserve more attention as therapeutic agents, under controlled conditions.
Unintentional injury from accidents and drug overdoses, according to one Continuing Medical Education (CME) course I took, is now in the top five causes of death. The course didn’t distinguish how the overdoses occurred, but my experience tells me a surprisingly large number of people take ten or more medications, don’t know what they are taking, how to take them, or what they are for. They don’t know about side effects, and their doctors don’t explain. They take them “when I feel like I need them.” or don’t take them at all if they can’t afford the cost.
Direct-to-consumer advertising by pharmaceutical companies has grown exponentially since it was approved by the FDA in 1997. Pharma spent less than $800 million/year on advertising in 1996, but by 2000, that sum grew to $2.5 billion. Of that, 20 percent was for psychiatric medications, and these constituted 10 percent of the top 100 selling drugs.
Obviously, there is a great demand for “feel-good” drugs, either over the counter or under the counter, and I have to wonder why. From what I’ve seen, none of these drugs satisfies the long-term cravings of those who have lost their way. The psychiatric drugs, like antidepressants, are not proving themselves over time, so there is a constant turnover of medications used to treat depression. Yet advertising, the “health care industry,” and the world at large seems to believe there is a quick fix to problems, lifestyle problems, relationship problems, financial problems, employment problems, health problems, loneliness problems, and all the problems people’s fantasies tell them should respond to drugs.
As long as people put faith in solutions outside themselves, they will be disappointed, I believe. Maybe a pill can help, temporarily, but there is no pill for financial problems, unless you’re selling it on the street.
That, in summary, may be the underlying impetus behind the “opiate crisis.”