Prescription Drug Addiction: A Medical Condition, Not A Moral Failure

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Prescription drug abuse and addiction is prevalent in America yet it lurks in the shadows. We don’t like to talk about it because of the stigma associated with it. But if you are still reading this, you probably know someone close to you it has affected. This is an issue that is near and dear to me and my family.

Both of my parents own pharmacies (my father’s is in Attleboro and mother’s is in Plainville). Both have had their share of robberies from persons suffering from drug addiction. In September 2010, there was a well publicized case of a 17 year old boy found nearly comatose in the ceiling of Plainville Prescription Center. That is my mother’s store, and it wasn’t the first break-in she or my father has experienced.

A few weeks ago, an old friend recently succumbed to a long fight with mental illness and she intentionally overdosed on pain killers – mental illness is a serious risk factor for drug abuse. Another person close to my family, who has long suffered from back pain, also became a victim to pain killers, which many people fall victim to. He is currently in residential rehab with the full support of his family. Prescription drug addiction affects men and women, young and old, employed and unemployed, and those suffering from mental illness and those who don’t. In short, no group is immune.

While I have never even had so much as a drink of alcohol in my life, (it may be hard to believe but it’s true) before you question the type of people I surround myself with, facts are important and sometimes a wake-up call to the judgmental. Consider that in 2007, nearly 28,000 Americans died from unintentional drug poisoning, and of these, nearly 12,000 involved prescription pain relievers. Prescription drug abuse surged 400 percent from 2000-2010.

Drug addiction is a problem that can originate with chronic mental illness or legitimate physical or psychological pain. Drug addiction is a medical issue, not a moral one. Drug dealing, however, is a different issue, and to be clear, a serious crime. Some people think abuse or addiction are moral issues, some a criminal issue and others a medical issue. There is a difference between use, abuse, and addiction.

A Brain’s Cheap Thrills

Drug use and non-addictive abuse are cheap thrills for your brain’s dopamine receptors (think of dopamine as the neurotransmitter in your brain that allows you to experience pleasure; without it, no pleasure). However, when abuse becomes addiction, we are talking about a physically altered brain. The brain becomes incapable of producing dopamine, or the pleasure receptors in the brain become incapable of receiving enough dopamine. The only way for some individuals to feel any pleasure, or no pain, is through excessive use of drugs. While drug experimentation may be a moral issue or an issue of poor judgement, drug addiction is more than a moral issue. In fact, I would not describe it as a moral issue at all. It becomes a physical one and one that is the equivalent of a hawk sinking its talons into prey.

Addiction is not something that someone can just snap out of.

One recent study found that over two-thirds of people who who used illicit drugs for the first time in one recent year began by using prescription drugs medically. In 2009, the number of first-time, non-medical users of psychotherapeutics (prescription opioid pain relievers, tranquilizers, sedatives, and stimulants) was about the same as the number of first-time marijuana users. Prescription drugs are the second-most abused category of drugs in the United States, following marijuana, which usually has much less serious consequences than prescription drug abuse and dependence.

There is clearly a need for effective measures to prevent prescription drug abuse and addiction. The recent initiative in Attleboro, to give back unused prescription drugs, made me first think of gun buy-back programs. Gun buy-back programs were attempts by local police to allow citizens to sell their guns to police as a way to decrease the number of guns in a community. The hope was that it would decrease gun crime. Gun buy-back programs were a failure; they did not reduce gun violence or illegal carrying. I wonder if this program will have similar outcomes. I hope not. I don’t see the harm that can be done by such a program, and there is reason to believe that the dynamics of abusing guns and prescription drugs are very different.

An Opportunity and Obligation in Massachusetts

If we look at the base-rate of prescription drug abuse in our community and other communities not doing this initiative, then compare rates of prescription drug abuse after this initiative has been implemented, and compare it to the pre-post rates where this has not been done, we can have some sense of whether or not this initiative helped decrease prescription drug abuse. This is a thumbnail sketch of a research design and there are a lot more details that need to be considered.

The point is that when we measure something correctly, we can then have the evidence that we need to make a case for or against something.

Measurement for public policy my seem like an academic exercise. It may seem needless when someone has the proverbial “commonsense” – which is often what people claim to have when they don’t have facts to offer. But I think that such measures are a way to get to the fact of the matter and push good policy. And real commonsense dictates that evidence based on a measurement of the real world is far superior to speculation or no evidence at all.

Ryan

The person who broke into my mother’s store in 2010, Ryan, had people around him who care and a criminal justice system that recognized his unique needs. He has received treatment, tough love, sanctions and he is doing much better now. Let’s hope he stays that way.

Paul Heroux has a Bachelor’s in Psychology and Neuroscience from USC, a Master’s in Public Administration from the Harvard School of Government, and a Master’s in Criminology from the University of Pennsylvania, and worked for a jail and prison for 4 years. Paul can be reached at PaulHeroux.MPA@gmail.com.