Starting the Conversation

When covering the subject of addiction, the simple and alarming truth is that the most abused drug and the most fatal drug are one in the same and you can probably find it in your very own medicine cabinet. It is legal and shockingly common in America today--and we know it by the name of opiates or painkillers. The National Safety Council (NCS) reports that sixty people die every day as a result of opiate overdose--and this figure does not even take into account the deaths that result from complications resulting from the medicine. This means that in a year’s time we lose enough people to opiate overdose to constitute the population of a small town.

What defines the unique risks associated with this epidemic is the surprisingly naive mindset of opiate users, who in a public poll reported no worries about opiate addiction at a rate of 9 out of 10. These users maintained self confidence in their opiate use, despite 60% of whom having reported risk factors that would make them uniquely sensitive to the dangers of opiate addiction. This denial of negative outcomes explains at least in part the rapid growth of both traditional opiate prescriptions and their abuse at the street level.

Unfortunately the negative outcomes of opiate abuse are more complex and numerous that we may have previously thought. NCS conducted a review of medicare data and found that opiate users suffer four times as many fractures, which puts them in a situation of great risk, since they will be experiencing a large amount of pain, which is both a trigger for opiate addicts and enablement as such an injury is a pathway to continued prescriptions of opiates. Opiate users are also at a much greater risk (68%) of being hospitalized due to an adverse drug event. NCS also found that opiate users suffered an 87% greater risk of dying during the study period as compared to the control group.

So with such a blatantly bleak prognosis at the scale of a country-wide epidemic, why was the problem left alone for so long? Who is to blame, and how can we counteract their corruption or ineptitude? As an addiction counselor, I am in the lamentable position of having seen these problems develop first-hand. I have heard the stories from family members who have lost their loved one to this epidemic, and I have counseled those who seek a better path. In this article, I will provide some of my insights alongside the historical answers to the questions listed above.

The Opiate Crisis in America

As coverage of the opiate epidemic became mainstream, policymakers--faced with the deaths of high profile celebrities and politicians--scrambled to enact some sort of measurable change. They began in probably the correct place, that is, with physicians. Policy and education initiatives sought to tighten the screws on the medical field’s prescription of opiates, which had grown to disastrous levels following the market dominance of drugs like Oxycontin. While these changes did aid temporary repression of growth rates in the epidemic, the introduction of the drug fentanyl changed all of that, reinvigorating abuse behaviors due to the strength and affordability of the drug.

A 2019 story in the Atlantic ran that detailed these events, and showcased receding markers in the opiate epidemic with the caveat that the mishandling of both opiates and opiate users was widespread. The basic findings of corrective approaches to the industry seemed flawed in two ways. Firstly they seemed to have overestimated the risk of opiate abuse in the average person, thus rendering it nearly impossible to obtain for many who truly needed such medication. Secondly, efforts seemed to underestimate certain genetic and epigenetic risk factors. For instance, depression and anxiety in the presence of a genetic history of addiction represents an extremely grave risk for addiction--yet such patient backgrounds were often ignored in the name of expediency.

The takeaway for me here is that the opiate epidemic was one caused by the medical industry become too depersonalized from its patients, and thus it cannot be solved by top-down depersonalized solutions. While the wide sweeping changes made at the policy-level have assuaged the problem somewhat, they by no means offer a long term terminable solution. The area where this is most clear is within the area of opiate users or addicts in continuous treatment. In other words, how are patients who have a history of opiate abuse supposed to handle pain?

Impersonal Medicine

It should be mentioned here that I discussing extreme pain--not the simple ouchies of a skinned knee or sprained ankle. When someone is battling a potentially terminal illness such as cancer, what is our stance on opiates then? Or if an opiate user is a brutal accident and is suffering in the emergency room--what then? These issues are only more befuddling when you introduce an emerging field of treatment wherein certain opiates are prescribed as long term treatment of opiate abuse.

Drugs like suboxone and buprenorphine act as opiate receptor antagonists in the brain, and thus are becoming more and more popular forms of treatment for long term opiate abusers. But then, how are we supposed to handle these individuals in cases of illness or injury when their treatment regimen entails the blocking of painkiller effects. It may be easy to pass judgment and ask these individuals to stomach their suffering as a consequence of poor decisions, but the problem is that many individuals arrived at this reality due to the irresponsibility of medical professionals and through no fault of their own. Companies are rallying behind the flag of medicine for these individuals through communities that offer guidance or advice, or through solution-minded directories. And what’s more important to note here is that by inaction or through unoffered solutions--we are in essence, encouraging these individuals to seek their own solutions. And sadly, the most common solution for opiate users to seek in such situations is that of heroine.

Heroine is not regulated by doctors following red tape, it is an extremely potent painkiller, and it offers sedative qualities as well. Thus it represents an all too common pathway for opiate users or for addicts who have found their path to recovery fraught with the dysfunctionality of treatment systems and the uneducated providers.

So what is the core problem here? It is my belief that the core problem here is one scale and impersonalization. In America’s 2019, every industry in our country has been undergoing the facelift fueled by the advent of the internet and modern technology. Like any other, the industry of medicine has gone similar expansions and renovations--but this I believe is exactly where we see the train go off the rails. Medicine in its very core is an individualistic focus of attention towards the betterment of that person’s health. If the industry continues to expand to the point of being unable to adequately consider the value of the individual, then we will continue to see the downfall of the many, whose care was never truly given.

Author's Bio: 

I am a psychologist, philosopher, and entrepreneur with an interest in how we handle substance abuse and addiction in America. I am currently working on a book wherein I will publish the results of my independent findings, but at the core of my passion is my intention to restore in people the genuine desire for truth and understanding of addiction in America through true comprehension rather than assumption or denial.