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Drug Addiction as a Public Health Issue


After decades of failed policy, we may finally be seeing drug addiction as the complex health issue it really is, rather than treating it as a law enforcement problem.

The height of the War on Drugs is well past at this point. The ‘80s and ‘90s remain the high water mark of that particular joint federal-state effort. Countless lives have been lost or destroyed in the meantime, civil rights violated on a large scale, and for what? Apart from the military-industrial complex, it’s hard to imagine a more profound and tragic waste of money, resources, and human potential.

The bitter irony is that it took white people falling victim to drug abuse at epidemic levels before we started to make sympathetic motions. The recent wave of heroin addiction that’s hit suburban and rural white populations seems to have finally awoken our basic respect for human beings who suffer from drug problems. We should take a good, hard look at why that was necessary in order to see the issues as they really are: as problems of public health, not criminal behavior and legal process.

For now, it is probably enough to say that our drug policy has always been racist–from marijuana being outlawed over fears of “disruptive Mexicans,” opium’s association with the Chinese leading to its ban, to the inner city crack epidemic of the ‘80s bringing harsh new penalties to bear against the black community. That a predominantly white population, when struck by a similar affliction, receives so much sympathy and attention, says many unpleasant and uncomfortable things about the ways our public policy priorities interlock with racial prejudice.

But let’s not look a gift horse in the mouth. Efforts to shift focus from criminal prosecution and imprisonment to treatment and health management have come late, but at least they have come at all. What is important is that we stay this course and ensure that politicians don’t repeat what has already been a ghastly, lengthy, costly mistake.

Being a solution-oriented person, the obvious question is: what can we do about drug addiction? The answer is multifaceted–there’s no one solution. Perhaps the most difficult conclusion for me to arrive at is that, for many people, the answer is “nothing.” There is nothing to do, not because people are hopeless, but because there isn’t actually a problem. There are plenty of people using drugs recreationally who function just fine and don’t need anyone butting into their lives. This is slowly becoming the norm for marijuana and other drugs may not be far off. While this may not be ideal, there is no sensible reason to lock anyone up for using drugs.

Another aspect at this level is harm reduction. Offer intravenous drug users clean needles and safe places to inject. This is not the slightest bit radical. The Centers for Disease Control fully recommend such services because they are instrumental in stopping the spread of HIV and other blood borne diseases.

What about people who are addicted but don’t want to be, or whose addiction is seriously degrading their quality of life? Help should and must be available. Since many people dealing with addiction currently got there through the use of opioid painkillers, which means the trouble originated with a pain condition, Suboxone is becoming a popular treatment option. It blunts the symptoms of withdrawal while being a pain reliever in its own right. Unfortunately, due to federal regulations, Suboxone is not easy to come by in the US. Doctors are permitted to hand out limited numbers of prescriptions for it. This seems to be motivated by the same supply controls that led to the current heroin epidemic in the first place. Suboxone itself is potentially addictive, but much less so than other opioids, and it is extremely effective at its intended purpose. This is an area where better policymaking and federal rulemaking could have a huge impact.

One drug that is on its way to changing how we deal with opioid addiction is Naloxone, also known as Narcan. It can be used to treat an overdose-in-progress, is harmless in patients not currently suffering an overdose, and can be re-administered multiple times if the initial dose was insufficient. There are not a of medications that could rightly be called “miracle drugs,” but Naloxone is one of them. There are efforts underway across the country to increase access to Naloxone for virtually everyone–emergency responders, bystanders, family members. Heroin overdoses killed over 10,000 Americans in 2014, more than doubling from 2011 when the latest epidemic began in earnest. People do not need to keep dying this way.

Regarding drug addiction more generally, treatment is complex but achievable given time and commitment from the patient, their family, and medical providers. Over the past several years, it’s become more and more evident that the old standby–the 12-step program–doesn’t really work. Instead, real addiction treatment consists of a combination of medical disciplines. It must be determined if any physical ailments underlie the addiction–such as the acute or chronic pain that leads many to painkiller addiction. It’s also common for addiction to develop as part of a mental coping strategy, a maladaptive behavior designed to help the individual deal with depression, trauma, or other psychological problems. Other medications and treatments may therefore be warranted in treating the underlying sources of one’s addiction–but the addiction itself can remain an ongoing concern, requiring support and monitoring from family and medical caregivers.

Above all, people struggling to break addictions that are seriously impacting their lives need compassion, support, empathy–and competent medical assistance. It is not a matter of weakness or willpower, but health and science. It finally looks as though this country is coming around to the reality of the situation and beginning to address it as a public health concern. This could stimulate more research into better and more effective treatments, too. It is also my hope that we do not forget how pointless and destructive the War on Drugs was–how many people it has incarcerated (and how many still remain behind bars), how many families torn apart, how many lives disrupted or destroyed, how much time and money and resources wasted that could have been put to more constructive use.

Like I said, better late than never.

Photo by Kazarelth