What “War” on Drugs?

“We lost more people last year than the entire Vietnam War and Korean War combined.”

I received this text on a frosty Sunday morning from a friend who is a cardiologist. He can not ignore the obvious. Every emergency room bed is filled up and down the East coast. Patients line the corridors in gurney traffic jams.

So how are we addressing this home grown war of epic proportions?

JP Clark, West Point professor and author of “Emergence of the New Modern Army,” explains that the US military prepares for war by planning during peace time. Makes sense.

The US has spent a lot of money, and time, attempting to stem the flow of drugs and incarcerate dealers. I am not opposed to either effort – but it has been a one-pronged enforcement driven approach. Notably; the drugs have not been contained. They continue to cross the Mexican border, and be flown in from China and Afghanistan. But before preaching isolationism consider the role of American pharmaceutical companies and script writing doctors…

According the to the Nat’l Institute on Drug Abuse, 80% of all heroin users began their addiction with access to a legal opiate prescription. Let me say that again. 8 out of 10 American youth are shooting up, stealing, selling themselves and dying because they had access to a legal prescription. Prescription opioids such as OxyContin and Percocet ARE Heroin in pill form. The molecular structure of these opiates is nearly identical and are all derived from the poppy plant. All are extremely dangerous and highly addictive forms of pain relief.

Purdue Pharmaceutical, the maker of OxyContin, knew this. But profits were just too good to share that information. (Purdue has since paid $635 million in fines after pleading guilty to false marketing charges.)

Insurance companies happily complied. Pills provide an immediate short term solution for pain, and are more cost effective than lengthier physical and holistic therapies. Insurers then began to base doctor compensation on pain management. (If you are envisioning a noose around patient necks… you are seeing correctly.)

Recently the AMA, after a judicial wrangle, reluctantly agreed to limit first time prescriptions. But the war has not been won….victory does not include leaving the troops behind.

We need immediate investment in rehabilitating our sick youth and adults.

Medicine is a big, big business, right? According to B. Lee in Forbes Magazine, “seven of the top ten profitable hospitals in the US were non-profits.” (Your eyebrows should most definitely be raised.) He quotes, “the system is broken when nonprofit hospitals are raking in such high profits. The most profitable hospitals should either lower their prices or put those profits into other services within the community.” Well why not push for a large percentage of those profits to be spent on improving addiction services?

Being a foot soldier, I have suggestions.

1. Outpatient service; often the first line of treatment, is notoriously ineffective. Heroin is classified as the most addictive drug on the planet with 1/4 becoming instantly addicted. (It also creates real physical and physiological changes to the brain.) Outpatient might be a form of acceptable treatment for marijuana abusers or sex addicts… but certainly not for heroin addicts. Why do we accept this as a permissible form of care?

2. If you are lucky enough to advocate for inpatient care, two weeks is the average stay. Two weeks only reduces tolerance and increases risk of fatal overdose. 90 days is the minimum amount of time needed for treatment to “catch.” (A full year is required for normal brain functioning to return.)

3. Removing an addict from their environs is important for success. Addiction is a brain disease. Removing quick access to destructive behaviors and people makes rehabilitative sense. There should be a demand for quid pro quo arrangements with out of state insurers to benefit those with HMOs and medicaid plans. We must find a way to do this or else only the rich or those with premium insurance plans will benefit.

4. Spiritually based programs work. Addiction is a disease that requires a form of “spiritual surrender.” That doesn’t sit well with some because it seems to imply an inherent moral failing or belief in God. Neither is true. What it fosters is recognition that self reliance is not an option when you suffer from a mental illness like addiction.

5. An increase in MAT (medication assisted therapy). Some addicts need it – and right now the number of physicians licensed to prescribe it is too low.

6. Increase the number of physicians going into adolescent psychiatric care. (One reason there are so few is because they are paid much less by insurers for their work.)

If we don’t do these things we will continue to watch our youth die.

My daughter has lost many acquaintances. Twenty-two to be exact. One male friend I recall frequently. He had a “thing” for her and had stumbled all over himself buying her shoes, groceries, and red roses. The relationship didn’t last, and he texted me, desperate, that he was “heartbroken and would never love again.”

It all seemed so overly dramatic. But he was right; he never would love again.
A week later he was dead from an overdose. He was just 22.

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