Hardly a week will pass, especially in this election season, when concern regarding the rising number of deaths associated with overdoses on opioid medications and their illicit counterparts like heroin. This concern is warranted.
That said, with the spotlight of concern focused squarely on opioids it is easy, especially for the lay public, to lose sight of the larger issue of the impact “all” substance use in general and substance use disorders (SUD) specifically have on contemporary society. Consider tobacco & alcohol, two popular and legal psychoactive and potentially addictive substances.
Most purchases of these substances are by those who have developed a psychological if not physical dependency, A.K.A., a SUD - 10% of drinkers consume 50% of the alcohol sold in this country[1]. Add to this my personal guestimate, based on years of experience, that 80%+ of tobacco users are
dependent on tobacco and you begin to realize that the most frequent consumers of these legal substances are those whose use is more a function of need than choice, dependence rather than volition. If all those dependent on alcohol or tobacco were to miraculously quit tomorrow, there would be a major and devastating impact on our economy bot to mention the fiduciary responsibilities of local, state, and the federal governments.
Relatively few users OD on alcohol and I suspect none on tobacco (although nicotine is a potent poison when administered directly and in higher doses as in insecticides). Consequently, opioids garner more attention and concern than do alcohol and tobacco although the concern is focused on consumer use rather than on the availability of these prescription drugs. A side note...as we have seen with the legal production and marketing of any psychoactive substance, it is the “wet moral model” that drives public opinion regarding addiction and other problems associated with consumption. This model argues that it is a lack of consumer willpower to use these substances correctly and/or the consumer's moral turpitude that results in any problems associated with use...not the substance itself. Put more succinctly, those subscribing to the WET MORAL MODEL argue: I drink/use tobacco/take pain medication and do not have a problem so it is obviously the personal issues "of those people" that give rise to "their" problems, not the drugs themselves.
But I digress…In a society where the proverbial squeaky wheel gets all the grease, until and unless the public raises the issue of overproducing opioids to a tipping point, nothing is going to change. That said, I personally do not believe that the availability of legally prescribed opioid medication is “the problem”; it is the unbridled production of that medication and the unrelated but nonetheless confounding factor of under-informed physicians who overprescribe that is. It is the confluence of these issues—the unbridled production of opioid medications by big pharma coupled with over prescription by the medical professional—that give rise to the “opioid crisis.” NOTE: Opioids have been used since time immemorial to assuage pain and facilitate healing…all fans of Game of Thrones are aware of the role that the “milk of the poppy” play in Martin’s books. “Pain” was added as a “vital sign” by the medical profession in the late 20th century, although that decision has not been called into question. The management of pain, however, is an important adjunct of the healing process following some surgeries and in mitigating the symptoms of specific diseases. For these reasons, opioid medications are important and productive. That said, the production of as much of these medications as the market will consume and/or their prescription in quantities that surpass the likely need only invites the type of problems we associated with opioids that currently exists.
In 1983 I had major surgery to address the loss of the use of my left hand. Upon discharge, I was given a script for Tylenol-3, which is Tylenol with codeine, a relatively minor opioid medication by today's standards but a script nonetheless that was both appropriate and appreciated. When taking the script to the pharmacy I asked the pharmacist if he would just give me 10 pills to carry me through the first couple days of my recovery rather than fill the entire script which was for considerably more, if I recall about a month's supply. I was told that by law pharmacists had to fill the scripts exactly as written but I would come to really appreciate how well they worked on headaches! Now, I realize that 1983 was a long time ago...perhaps before some readers of this missive were born, but the point remains: This combination of physician overprescribing and pharmacist response to a request for less medication may have something to do with why we have the problem we do today. Fortunately, Tylenol-3 did not induce, for me anyway, euphoria and only managed the pain associated with recovery...and I discovered that Tylenol with caffeine rather than codeine did a much better job managing my headaches...and yes, I am aware of the irony here as caffeine is a drug, just not an opioid J
By way of closing, I applaud those who have raised the issue of opioid use to its current level of awareness as we do need to address this important issue. However, I suggest that the rest of us whose awareness of opioid use disorders has become acute do not overlook the fact that the costs—economic, emotional, legal, and social—pale to almost insignificance when compared with those of alcohol and tobacco and their impact on public health, quality of life, and the economy in general.
What do you think?
Dr. Robert
[1] Cook, Philip J. (2007). Paying the tab: The cost and benefits of alcohol control, Princeton University Press. NOTE: see https://tinyurl.com/10drink50 and scroll to page 57 for details including rates of consumption for others portions of the population.
No comments:
Post a Comment
Thoughtful comments, alternate points of view, and/or questions are welcomed.