Category: Addiction

Everyone’s life has been drastically altered in the midst of this pandemic. The economic hardship, isolation, stress, and loss that it has brought on have had palpable ramifications which are evident in the recent rise in violence, suicide, overdoses, and drug abuse. While Covid-19 has brought some of these issues to the forefront of discussion, the underlying mental health implications are often overlooked. The unpredictability of these times has been inevitable, but the way we cope with feelings of loneliness and the resources we make available to those facing these challenges are very much within our control.

Losing loved ones, a job, or even just the ability to live freely can cause extreme stress and frustration, and those who have resorted to drug and alcohol abuse in the past are left in a particularly difficult situation. In June, the CDC reported that 13.3% of people in the United States began or increased substance use to deal with the emotional effects of Covid-19. The Overdose Detection Mapping Application Program, a tool that tracks national overdose data in real-time, also showed a steep 17.59% increase in overdoses following the enactment of stay-at-home orders, and death due to overdose went up by 50%. Acknowledging these statistics and keeping the general public informed has created some reassurance that there are better times ahead. However, for many dealing with addiction, promises of light at the end of the tunnel may be discouraging when the estimated return to normal life keeps being delayed indefinitely. In the meantime, resources originally dedicated to addiction recovery efforts are being allocated to deal with the current public health crisis (Gold 2020).

While it has been established that the relationship between Covid-19 and increased substance abuse is causative, it isn’t unidirectional, making the lack of resources for individuals in recovery even more upsetting. Substance use disorder has been found to put people with Covid at a higher risk for more serious complications, and these individuals are also more likely to contract the virus in the first place (National Institute 2021). This leaves them in a vulnerable position, but the underlying role of declining mental health which lies at the center of this issue and fuels this cycle has been overlooked until very recently.

The pandemic has ultimately served as a learning experience, and despite the negative impacts it has had, there are signs that society is about to come back stronger and smarter than before. Starting in 2022, the Federal Communications Commission voted to change the suicide hotline to the three-digit number 988, so that there is easier access to this service. Since this is much easier to recall than the current number, this small change has the potential to save countless lives (Stracqualursi, 2020). Additionally, federal agencies have implemented policies allowing for more funding for telehealth services, and Alcoholics Anonymous has begun to offer online meetings (Gold, 2020). These changes also hold symbolic significance, representing the recent and historic recognition of the importance of mental health.

 

References

Gold, J. (2020, December 15). Overdoses are increasing in The U.s. OVER Covid-19: Here’s what addiction experts want you to know. https://www.forbes.com/sites/jessicagold/2020/12/14/overdoses-are-increasing-in-the-us-over-covid-19-heres-what-addiction-experts-want-you-to-know/?sh=69d319834ffa. 

National Institute on Drug Abuse. (2021, February 12). COVID-19 Resources. National Institute on Drug Abuse. https://www.drugabuse.gov/drug-topics/comorbidity/covid-19-resources. 

Stracqualursi, V. (2020, July 16). 988 to become 3-digit number for national suicide hotline in 2022. CNN. https://www.cnn.com/2020/07/16/politics/fcc-national-suicide-hotline/index.html.

Factors that contribute to an individual’s risk for substance abuse are often perceived as variables outside of their control.  Although not very empowering, this is largely an accurate supposition, as 40 to 60 percent of a person’s risk is based on genetics alone. The remaining 60 to 40 percent is thus composed of environmental factors which are many times also the products of fate.  The community in which one grows up, the guidance of parents and role-model figures, and socioeconomic status all play a role in exposure to drug use at early ages and thus impact the likelihood of drug abuse in adulthood.  This does not suggest that everyone with such risk factors will inevitably fall victim to drug abuse at any point in their lives, but it does highlight the illogical and arbitrary nature of this disease (Addiction statistics, 2021).  It is therefore important to be mindful of the factors within our control so that we can do everything in our power to mitigate the risks.  Because mere circumstance can have such profound consequences, it should be no surprise that one’s career can also dictate one’s predisposition to substance abuse.  Statistical analyses of different career paths indicate that restaurant workers, healthcare professionals, and artists are the three jobs with the highest rates of substance abuse (Sutphin, 2021).  The variety within this list may seem odd at first glance, as it appears to encompass a plethora of different skills, environments, and personalities. However, the underlying forces at play here can be easily explained by the fundamental concepts of culture, demand, and availability.

The culture of any workplace refers to the atmosphere of the environment and the behaviors that are considered socially acceptable there.  Fourteen percent of artists and entertainers report drug use in the past month, and this is likely due to the flexibility of their schedules and lifestyles alike.  Individuals in these more creative fields often select these careers because they are free spirits who do not wish to be bogged down by professionalism and the structure of a nine-to-five desk job.  While this lack of rigidity is often crucial for them to successfully create their masterpieces, this type of relaxed environment can lead to increased drug use and misuse.  Since drugs and alcohol are also glorified in pop culture, Hollywood, and the music industry, fledgling artists are likely to want to emulate this in order to fit into the culture associated with their career choice.

The desire to be accepted by people that are considered experts in a given field even has a biological basis, as a recent study was able to identify validation in the brain through fMRI imaging.  The brain activity of 28 individuals was found to be higher in the ventral striatum, which is the reward center of the brain when they were told experts agreed with their top choices of music.  The study also showed that there was variation among the participants, so it could be assumed that the impact of an expert’s confirmation would only be exaggerated if the participant prided themselves on their music taste or dedicated their lives to making art.  These results are also thought-provoking since they suggest that the very reward center that plays a key role in the process of addiction is also involved in driving people to value and conform to the existing cultures of substance abuse for the sake of fitting in (O’Callaghan, 2010).

Culture is also applicable to the situations of restaurant workers.  According to the National Survey on Drug Use and Health, this job has the highest rates of both substance use disorders and past month illicit drug use (Sutphin, 2021).  This is likely due to the lower average age of this demographic, as young people are more likely to engage in heavy drinking and experiment with hard drugs. Younger adults also find themselves in more situations where there are people using drugs and drinking alcohol around them, which ties into the next component of this phenomenon, which is availability.  The more access or exposure someone has to drugs and alcohol, the more likely they are to partake in these activities in the first place. However, the concept of availability is perhaps even better suited to explain the astronomical rates of prescription drug abuse in doctors.  

While it may be expected that healthcare workers might abuse the drugs they have such easy access to, what is more, interesting is that doctors are even more likely to abuse prescription medication than their patients on prescription meds.  This suggests that access is an important yet incomplete part of a larger story.  Some experts have pointed to a combination of their education and their need to cope with high levels of stress.  As experts on these drugs who are deemed competent to assess when others need to take them, doctors may have fewer reservations about taking these drugs.  They may also be unable to properly self-diagnose, and as a result of the demands and high-stress levels associated with their jobs, they can turn to prescription meds as an escape  (What Professions, 2021). 

The demands of a job, the availability of drugs and alcohol to people that choose a particular career path, and the general culture associated with the career should all be taken into consideration, but at the end of the day, they should not prevent anyone from going into any of these areas of work.  We must simply be mindful of these risk factors and look out for the signs of addiction to prevent ourselves and loved ones from being impacted.  If anything, this just speaks to the fact that addiction can impact people from a multitude of different backgrounds and professions and for various reasons.

 

References

 Addiction statistics: Drug & substance abuse statistics. https://americanaddictioncenters.org/rehab-guide/addiction-statistics. 

O’Callaghan, T. (2010, June 17). The brain science behind why we care what others think. Time. https://healthland.time.com/2010/06/17/the-brain-science-behind-why-we-care-what-others-think/. 

Sutphin, A. (2021, February 4). What Professions Have the Highest Rates of Drug Abuse? (Top 10 Industries). The Recovery Village Drug and Alcohol Rehab. https://www.therecoveryvillage.com/drug-addiction/professions-highest-rate-abuse/. 

What Professions Have the Highest Rates of Substance Abuse? Mission Harbor Behavioral Health. (2021). https://sbtreatment.com/professions-high-substance-abuse/.

Today, anxiety and depression are at an all-time high, with one in every ten Americans on antidepressants. While this may suggest that mental health has taken a sudden turn for the worse, this is likely the product of heightened awareness about mental health in recent years. Rather than suffering alone, many have gained access to treatment, which has become increasingly available. However, this statistic does raise another concern. Doctors are well aware of the risks of these medications, so this is not a question of whether these medications are overprescribed, but rather whether the general public has been sufficiently educated about how these drugs work. Since the specific category of antidepressants called Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed type, it is critical that there is widespread awareness of the risks associated with them. Thus, answering common questions like ‘Are SSRIs addictive?’ and ‘What are the associated risks?’ can help to ensure the safety of individuals taking SSRIs and shed some light on the misconceptions surrounding these drugs.

SSRIs interfere with processes involving Serotonin, a neurotransmitter molecule which regulates mood and anxiety (Scaccia, 2020). While the exact mechanism behind this remains somewhat elusive, there are some theories as to how these drugs alter the biochemical processes in our bodies. Although some SSRIs like Lexapro target serotonin transporters and bind to them directly, recent research suggests this may not be their main function.  It has recently been discovered that these medications may target DNA to influence gene expression (Brogaard, 2017). By inhibiting the transcription of genes that code for serotonin transporter proteins, they can decrease serotonin reuptake by the axon terminal of the presynaptic neuron.  This increases the amount of the neurotransmitter left in the synaptic cleft which will then bind to receptors on the postsynaptic neuron.

In more simple terms, the more serotonin that is left in the space between nerve cells, the more it can impact the neighboring cell. However, there are transporter molecules at the ends of our nerve cells constantly working against this process and taking serotonin out of this space called the synapse, putting it back into the cell it came from (Silverthorn, 2019). This can be problematic because in order to achieve the mood-regulating effects, it must be sensed by the next cell, so it is better to have more of it in the synapse. It is now believed that SSRIs block the expression of genes that code for these transporter molecules, telling cells to make less of the things that are depleting serotonin levels in the synapse, allowing serotonin to reach the next cell. This would explain why it takes weeks to see the impact of SSRIs while drugs like ecstasy and cocaine, which work on the same transport molecules, have almost immediate effects. Just blocking these transport molecules is a lot faster than telling the body to alter its biological processes to produce less of them. 

Although the effects of SSRIs take a while to kick in, this should not necessarily be associated with milder effects. SSRIs are prescription medications used to treat anxiety and depression, and for reasons still unknown they only work in about 30 percent of patients. These drugs are also not generally classified as addictive, but this does not suggest that they do not have profound impacts on the body or that they are never abused or misused. Because their impact is more delayed and they lack the rush sensation that drugs like cocaine can elicit, they aren’t as appealing to addicts who crave this high. For this reason, they are also prescribed as a safer alternative to benzodiazepine (Brogaard, 2017). However, the problem arises when SSRIs are used for long periods of time, as their effects may begin to weaken. Patients can start taking more than prescribed by their doctors because they feel that a higher dosage is needed in order to alleviate their symptoms, and this can lead to an overdose. 

If a patient recognizes they are in a situation where they are becoming dependent on SSRIs to function normally or reach a point where no dose can seem to take away the pain that they are living with, they may become inclined to quit taking them. However, this is a challenging process which should only be undertaken with the supervision of a medical professional. It can also be difficult for patients to discern where they lie on this slippery slope, and they may not know when it’s time to seek help. If a patient finds that the SSRIs are taking too long to kick in or they begin to see a decline in their effectiveness, dealing with their symptoms of depression and anxiety in the meantime is also discouraging. Because these individuals have already sought out help from doctors only to be disappointed, research suggests that when feelings of helplessness emerge, they may be more susceptible to turn to other drugs and alcohol to numb their pain. This is also concerning because taking drugs and drinking while on antidepressant medication can cause serious symptoms like dangerously high blood pressure, intense sedation, and overdose (Antidepressant, 2020).

It is important to note that when used with caution and under the instruction of a doctor, SSRIs have allowed so many people to claim back their lives after long battles with their mental health. However, this is ultimately a balancing act. Educating people about how these drugs work and the dangers of their misuse works to ensure that these individuals aren’t controlled by their anxiety, their depression, or their medication. Unfortunately, despite the prevalence of SSRI prescriptions, there is still a stigma associated with these drugs and the mental health conditions that they are used to treat. On top of working to fight poor mental health and possibly drug dependence, these individuals are also forced to cope with judgement, so they often hide these internal battles from the world. This creates a vicious cycle that can just exaggerate the severity of their conditions. If you know someone struggling with their mental health, providing them with support, acknowledging their struggles, and encouraging them to seek help when needed are helpful courses of action. If everyone does their part to remain informed, it helps to ensure the safety of all individuals on these medications.

 

References

Antidepressant addiction and abuse. (2020, November 30). Retrieved March 13, 2021, from https://www.addictioncenter.com/stimulants/antidepressants/

Brogaard, B. (2017, February 08). Number one reason ssris take four to six weeks to work. Retrieved March 13, 2021, from https://www.psychologytoday.com/us/blog/the-superhuman-mind/201702/number-one-reason-ssris-take-four-six-weeks-work

Scaccia, A. (2020, August 19). Serotonin: Functions, normal Range, side effects, and more. Retrieved March 13, 2021, from https://www.healthline.com/health/mental-health/serotonin

Silverthorn, D. U., Johnson, B. R., Ober, W. C., Ober, C. E., Impaglizzo, A., & Silverthorn, A. C. (2019). Human physiology: An integrated approach. Harlow: Pearson.

While the term ‘addiction’ usually conjures up images of substance abuse, the original meaning of the word as defined during Roman times had no such implications (Potenza, 2014). The DSM-5 has recently taken into account more abstract addictions, characterizing behaviors like excessive gaming as possible addictive disorders to be researched in the near future. This is a step in reflecting a newfound understanding of just how broad addiction is. Recognizing non-substance addictive disorders allows previously overlooked conditions, like addiction to plastic surgery, be brought to light and taken seriously.

In today’s society where an unrealistic standard of beauty is upheld and elective cosmetic surgery is becoming widely available around the world, the amount of people deciding to go under the knife is at an all-time high. The latest innovations in plastic surgery have been game-changing, helping countless individuals achieve an outward appearance that is more congruent with their self-perceptions. Although this can instill confidence in some patients, studies have indicated that it can also go the other way.  The fine line separating people who have plastic surgery and people who are addicted to it is rooted in their motivation and the extent to which it interferes with their lives.  

Preoccupation with cosmetic surgery is currently considered a behavioral disorder (Plastic Surgery, 2020). While it is not yet fully recognized in the DSM as a true addiction, it is related to other underlying disorders that impact mental health, one being Body Dysmorphic Disorder, or BDD (The Recovery, 2020). This condition involves hyperfixation on what the individuals perceive to be imperfections in their appearances. The growing influence of social media coupled with the increasing popularity of programs like Photoshop have obscured our perceptions of reality, contributing to a rise in such disorders. It has been determined that scrolling through social media feeds for extended periods of time is associated with the decision to go under the knife in the future (Arab, K). Research also indicates that BDD is fifteen times more likely to be observed in plastic surgery patients, as they believe surgery will resolve their negative self-image. Sadly, many find that nothing is remedied in the long run, even after multiple procedures. While there is nothing inherently wrong with plastic surgery, individuals chasing unattainable standards of beauty are always bound to lose this battle because “no amount of cosmetic surgery will satisfy or equate to the picture of perfection that they have in their heads” (Plastic…Body Dysmorphic, 2020).

These individuals often sacrifice their physical health and mental wellbeing in the process of ‘correcting’ their appearances. Rather than endangering their health, they are urged to seek treatment for their underlying psychological disorders. This sometimes involves cognitive behavioral therapy, as it is common for people with BDD seeking cosmetic surgery to have comorbid Axis 1 disorders. These include OCD, depression, and social anxiety. Excessive plastic surgery is also linked to suicidal ideation and self-harm. Many studies have concluded that undergoing just a single breast augmentation surgery puts women at a consistently higher risk for suicide (Sansone, 2007). When these procedures become patterns fueled by the constant presence of an underlying mental health disorder, it is even easier to spiral down a dark path, especially without proper guidance or a strong support system. With frequent surgery also comes the frequent prescription of painkillers like opiates. As a result, addiction to cosmetic surgery is also associated with a higher risk of opioid addiction, which “can often make the symptoms of BDD worse and lead to poorer overall functioning” (Plastic Surgery, 2020).

Due to the gravity of these co-occurring conditions, there is an immense responsibility placed on plastic surgeons to make sure they look at their patient as a whole before picking up the scalpel. Patients’ motivations, physical states, and psychological needs are inextricably linked, but often doctors overlook mental health when they have been trained in surgery. As a result, it is imperative that they are mindful of the negative impacts of social media on mental health and how this may impact their patients’ decisions. Being able to identify their patients’ motivations and refer them to other specialists when needed ensures that all the procedures they perform result in happier, healthier outcomes.  

However, doctors are not the only ones that have an obligation to help people living with plastic surgery addictions. The average person must also take it upon themselves to spread positivity rather than words of hatred. Refraining from commenting on others’ bodies and from making derogatory comments about people who have gotten plastic surgery is important because it isn’t always obvious who is silently struggling with BDD or depression. Even models and influencers who are deemed beautiful by society may struggle to see themselves that way. For individuals with these conditions, one nasty comment can worsen their unfounded disappointment with themselves and their looks. If you know someone with these conditions, encouraging them and helping them to see the beauty within themselves can go a long way.

 

References

Arab, K., & Barasain, O. Influence of Social Media on the Decision to Undergo a Cosmetic Procedure. Plastic and reconstructive surgery. Global open. https://pubmed.ncbi.nlm.nih.gov/31592374/. 

Plastic Surgery Addiction – Body Dysmorphic Disorder. Addiction Center. (2020, September 18). https://www.addictioncenter.com/drugs/plastic-surgery-addiction/. 

Plastic Surgery Addiction: An Unhealthy Obsession with Perfection. Addiction Center. (2020, November 20). https://www.addictioncenter.com/community/plastic-surgery-addiction/. 

Potenza, M. N. (2014, January). Non-substance addictive behaviors in the context of DSM-5. Addictive behaviors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858502/. 

The Recovery Village Drug and Alcohol Rehab. (2020, December 29). Plastic Surgery Addiction: Is There Such A Thing?: The Recovery Village. The Recovery Village Drug and Alcohol Rehab. https://www.therecoveryvillage.com/mental-health/body-dysmorphic-disorder/related/plastic-surgery-addiction/. 

Sansone, R. A., & Sansone, L. A. (2007, December). Cosmetic surgery and psychological issues. Psychiatry (Edgmont (Pa. : Township)). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861519/.

Addiction can be an isolating experience, and battling it often requires a strong support system. Seeking rehabilitation and dealing with feelings of loneliness can be daunting obstacles, but they must be surpassed in order to get through withdrawal to attain sobriety. Unfortunately, these challenges are only compounded for people also living with sensory disabilities.  

A study by the National council on Alcoholism and Drug Dependence (NCADD) found that at least 600,000 people who are classified as deaf also live with an alcohol use disorder in the United States. Despite this statistic, the number of rehabilitation facilities that cater to the needs of people with hearing loss is disproportionately lower as compared to the prevalence of those for able-bodied individuals (Treating Alcoholics).  Since people who are visually or hearing impaired have limited options for rehabilitation, this may discourage them from seeking help at all. When they do take this step, many are forced into programs that don’t take into account their specific needs. For instance, individuals that experience vision loss may not be able to read literature offered in self-help groups, do homework assignments on their own, or even have easy access to the rehab facility’s buildings. People with sensory disorders may also have difficulty connecting with others in group therapy, making the road to recovery feel all the more challenging and isolating to them. 

There are many simple steps a rehabilitation center can take to help people with these disabilities, fostering success rather than isolation. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the addition of braille signs and the implementation of counseling treatment activities that are not sight-based can help people in the blind community take charge of their rehabilitation experiences. Staff that are trained in treating co-occurring disorders are another advantage of attending these specialized rehab centers, as they can anticipate and address the specific needs of these demographics. Group therapy with others who happen to experience vision or hearing loss is also very helpful, as it serves as a stronger support system. While all recovering addicts are united through their understanding of the devastating impact of drugs and alcohol abuse, individuals who are also blind or deaf can sympathize with each other on a deeper level. Feeling alone is a common obstacle in beating addiction, so having people with whom they can discuss specific struggles and coping-mechanisms makes for a more physically and emotionally successful recovery (Finding Capable).

The feeling of isolation, however, is not just a problem that these people are faced with during rehab, as it may actually contribute to rising rates of drug addiction among individuals with sensory disabilities. Children growing up visually or hearing impaired in today’s society can be subject to cruel treatment. Some are alienated by peers who have never been educated about the cultures of the deaf and blind communities or how to respect fellow students.  Not only are these individuals at a higher risk for bullying, but studies have shown that they are also less likely to have effective communication with their parents. It is common for parents to learn to read braille or speak sign language to better connect with their children, but having parents who can not take this kind of initiative due to a lack of resources is correlated with low self-esteem and depression (Overcoming Addiction, 2020). Yet another factor that is strongly correlated with poor mental health is physical and sexual abuse, and people who are deaf and blind are also disproportionally targets of such violence. Having a sensory impairment increases a child’s risk by an astounding 31% (Addiction Treatment, 2020).  Because these risk factors are all correlated with depression, they also make these children more susceptible to substance abuse as they develop unhealthy coping mechanisms.

This relationship between sensory disabilities, poor mental health, and addiction raises even more concern for the shortage of rehab centers for people in the blind and deaf communities. In addition to ensuring there are more options for such individuals seeking rehabilitation programs that will fit their needs, education about drugs and the dangers of addiction should be promoted. While this is usually a part of school curriculums, children with sensory impairments attending mainstream schools, either by choice or due to financial restrictions, may not have the same access to this information as their able-bodied counterparts. This topic may also be written off as a secondary component of their education and excluded in order to allot time for perfecting other skills that they may need to thrive in school, like reading braille (Overcoming Addiction, 2020).  However, increasing awareness about these dangers within these communities and recognizing the importance of mental health is essential to their wellbeing and should be prioritized.  

 

References

Addiction treatment for the deaf and blind individual. (2020, September 30). https://www.rehabcenter.net/rehab-for-deaf-and-blind/. 

Overcoming Addiction for the Sensory Impaired. Rehab 4 Addiction. (2020, December 23). https://www.rehab4addiction.co.uk/guides/overcoming-addiction-sensory-impaired. 

Finding Capable Treatment Programs for Blind Alcoholics. Alcohol.org. https://www.alcohol.org/disabled/blind/. 

Treating Alcoholics Within the Deaf Community. Alcohol.org. https://www.alcohol.org/disabled/deaf/.

In the week of the 2020 election, the residents of Oregon overwhelmingly voted in favor of Measure 110, a bill that will decriminalize the possession of illegal drugs like cocaine, heroin, and methamphetamines. Although it won’t officially go into effect until February 1st of 2021, this measure is a massive deal because Oregon is the first state to take such bold steps towards changing the way the law deals with drug offenses. According to this bill, if you are caught with a small amount of a hard drug, then it will be treated as a misdemeanor rather than a full-on crime that warrants an arrest. You can think of it as being on the same level as a traffic violation. Rather than facing jail time, the individual will be fined $100. However, this fine can be avoided if they agree to a health assessment at an addiction recovery center. This measure also seeks to expand access to addiction treatment facilities. As a state that has legalized the sale and possession of marijuana, Oregon plans to reallocate marijuana sales into these facilities, thereby helping people fight their addictions. 

This measure will significantly reduce the amount of money that is spent on drug law enforcement. In 2015, for example, the federal government spent about $9.2 million every day on the incarceration of individuals with drug offenses, or over $3.3 billion annually (Templeton, 2020). On top of that, the state governments spent about $7 billion that year. It is estimated that Oregon will save about $24.5 million between 2021 and 2023 (Templeton, 2020). This will allow more taxes to be available for funding other aspects of the community such as education and drug recovery programs for the very same people that this measure will keep out of the prison system. 

About one-fifth of the prison population is in jail for a drug-related charge (Pearl, 2018). Moreover, there is a significant disparity in the demographics for these kinds of arrests. Black Americans represent 30% of drug crime arrests, yet only 12.5% of them represent all drug users in the United States. Although white and black Americans use substances at an equal rate, black Americans are 6 times more likely to be arrested for drug possession. Decriminalizing drug possession would reduce the number of people of color who face harsh consequences for such petty crimes. Currently, with the way we deal with drug offenses across the country, having a drug offense can negatively impact one’s chances of getting employed. Even if they end up getting treatment, the record of their offense will follow them around and affect how other people view them.

Our society shames individuals who are addicted to drugs and our justice system reflects. It treats drug possession as an offense on par with robbery or assault. However, incarcerating individuals for possession of drugs may be doing more harm than good. Studies show that incarceration can actually increase the risk of dying from an overdose. In the first two weeks after being released from jail, an individual is 13 times more likely to die of a drug overdose than the general population (Pearl, 2018). 

Our justice system has been operating on the assumption that criminalizing drugs is enough to make people abstain from substance use. Such an approach is ineffective because addiction is a chronic disease. People can’t just stop abusing drugs that they are so physically dependent on. The criminalization of drugs has contributed so highly to the stigmatization of addiction that it prevents people who suffer from a substance use disorder from stepping forward and seeking professional help for their addiction. Oregon has recognized that drug addiction is a public health crisis rather than a moral wrongdoing that warrants punishment. They are the first state to decriminalize drugs, and hopefully will not be the last. 

 

References

lechenie-narkomanii. (2016). Freedom, Sky, Hands, Handcuffs, Clouds, Man. In pixabay.com. Retrieved from https://pixabay.com/photos/freedom-sky-hands-handcuffs-clouds-1886402/

Pearl, B. (2018, June 27). Center for American Progress. Retrieved November 8, 2020, from Center for American Progress website: https://www.americanprogress.org/issues/criminal-justice/reports/2018/06/27/452819/ending-war-drugs-numbers/

Templeton, A. (2020, October 14). Measure 110 would make Oregon 1st state to decriminalize drug use. Retrieved November 8, 2020, from opb website: https://www.opb.org/article/2020/10/15/measure-110-oergon-politics-decriminalize-drugs/

In 2018, opioids were responsible for nearly 70% of drug overdose deaths (“Understanding the Epidemic,” 2019). That’s 128 people per day who lost their life to an opioid overdose (including both prescription and illicit forms). The National Institute on Drug Abuse estimates that 20-30% of patients who are prescribed opioids for chronic pain misuse them, or take a dose other than prescribed by their doctor. These individuals are then likely to transition to heroin, a more potent drug which delivers greater amounts of pain relief and euphoria. An alarming 80% of heroin users report that they started using the drug after the misuse of prescription opioids (“Opioid Overdose Crisis,” 2020). This raises the question: why would a physician ever prescribe a drug that is so addictive and life threatening?

To understand how this drug destroyed the lives of so many Americans, it’s important to look at the history behind the opioid epidemic. The first surge in opioid addiction and opioid-related deaths occurred in the 1990s when doctors began prescribing opioids to relieve pain at much higher rates than ever before. The sudden rise in prescriptions was fueled by pharmaceutical companies who falsely assured the medical community that opioids were perfectly safe and carried little to no risk for addiction. This claim was derived from a single faulty letter published in the New England Journal of Medicine in 1980. Titled “Addiction Rare in Patients Treated with Narcotics,” the letter reported that out of 12,000 hospitalized patients that received a narcotic (another name for opioid) only 4 patients had developed an addiction. 

These too-good-to-be-true findings were the result of a flawed methodology. The doctor who wrote this letter observed individuals who were admitted to his hospital for a short stay. Whether those individuals continued pain medication use after they were discharged from the hospital is completely unaccounted for. Furthermore, they did not observe patients with chronic pain conditions, which calls for extended use of pain medicine. We know today that long term use of opioids is associated with developing a tolerance, meaning that more of the drug is needed to feel the same amount of pain relief, putting the patient on an ever-increasing dosage (“Prescription Opioids,” 2019).

Although the over-prescription of opioids clearly has had devastating effects on the public for several decades now, physicians still reach for opioids as the first line of treatment for people who experience moderate to severe pain. This trend is largely driven by how lucrative the business of opioids is. Opioids do not treat the injury or underlying cause of the pain. They simply mask it. Thus, when the pain relief effects wear off, the patient will need to take more pills. Opioid manufacturers reimburse doctors for every opioid prescription that they write, so the more they prescribe, the more they will get paid (Kessler, 2018). Doctors are thereby incentivized to keep their patient reliant on opioids rather than exploring other avenues for pain relief. 

Not all doctors who prescribe opioids are doing so with the intention to hurt their patient though. It can be difficult to gauge the appropriate dosage to prescribe because pain is subjective and not something that can be measured with an instrument, like blood pressure, for instance. Doctors mostly rely on the patient’s account of their pain to decide how much they will prescribe. To help offset the possible risks of opioid use, the physician must carefully monitor their patient’s use, educate them on the risk for addiction due to misuse, and be aware of the signs of a developing addiction.

Medical school curriculum is also to blame for physicians’ overreliance on opioids for pain relief. In the United States, only about 11 hours are allotted for the topic of pain management (Shipton et al., 2018). Students are told to assess a patient’s pain level by asking them to rate it on a scale of 1 to 10. A higher rating equals a higher dose of pain medication, yet pain is more complex than that. A more useful assessment of pain would include asking the patient about how the pain is affecting their day-to-day life and ability to function effectively (Greenfieldboyce, 2019).

There are, however, alternative, safer forms of pain relief out there, which doctors aren’t encouraged to provide and not sufficiently educated about (Greenfieldboyce, 2019). One underutilized pain management technique is acupuncture. Acupuncture is a procedure in which hair-thin needles are strategically placed into the skin, around different parts of the body called “acupoints.” Although we don’t exactly know how this procedure eases pain, one theory is that the needles stimulate nerves, which send a signal to the brain to release endorphins (Temma Ehrenfeld, 2019). Endorphins are neurochemicals that, when released, have pain-relieving effects on the body. Endorphin is a combination of the word “endogenous,” meaning from within the body, and “morphine,” the commonly used opioid. Thus, they are considered our body’s natural pain relievers. In summary, acupuncture activates our body’s potential to heal itself. There are extensive studies that show the efficacy of acupuncture in treating back and neck pain, osteoarthritis, and headaches. Physical therapy and massage therapy are also promising lines of treatment that can have more lasting effects by restoring function to muscle groups and bones that are affected. 

For those who do not benefit from non-opioid treatments, there are some more advanced options such as administering radio waves, nerve blockers, and spinal cord stimulation. In a procedure called radiofrequency ablation, an electric current made by radio waves is delivered to the nerves responsible for the pain via a needle, thereby blocking the pain signal (“Non-Opioid Treatment”). One such procedure can produce up to a year of pain relief. 

Although pain is a physical sensation, emotional and physical wellbeing heavily interact with one another (Lee et al., 2017). Times of increased stress can greatly impact the intensity of one’s pain. Hence, psychological interventions like cognitive behavioral therapy (CBT) can be a great complementary option for pain management. Rather than blunting the symptoms of pain, this kind of intervention gets to the root and contributing causes of it. 

Unfortunately, health insurance companies do not typically cover the costs of these alternative pain management treatments. People are much more likely to get coverage for pain medication, making it the cheapest option. This is just a reflection of the influence that pharmaceutical companies have had in pushing opioids to the forefront of pain management. 

Opioids have been prescribed as the primary pain management tool for far too long. People who suffer from chronic pain deserve far better. However, making safer treatments more accessible to the public is easier said than done. It requires health care workers and policy makers to undermine the power of the prescription opioid manufacturers, educating doctors on the complexities of pain, as well as informing the public that they have other options and empowering them to vouch for higher quality pain management.

 

References 

Acupuncture: In Depth. (2016, January). Retrieved October 29, 2020, from National Center for Complementary and Integrative Health website: https://www.nccih.nih.gov/health/acupuncture-in-depth

Cafasso, J. (2017, July 11). Endorphins: Functions, Levels, and Natural Boosts. Retrieved October 29, 2020, from Healthline website: https://www.healthline.com/health/endorphins

Greenfieldboyce, N. (2019, September 11). How To Teach Future Doctors About Pain In The Midst Of The Opioid Crisis. Retrieved October 29, 2020, from Npr.org website: https://www.npr.org/sections/health-shots/2019/09/11/756090847/how-to-teach-future-doctors-about-pain-in-the-midst-of-the-opioid-crisis

Kessler, A. (2018, March 12). For doctors, more opioid prescriptions bring more money. Retrieved November 1, 2020, from CNN website: https://www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html

Lee, Y.-S., Jung, W.-M., Jang, H., Kim, S., Chung, S.-Y., & Chae, Y. (2017). The dynamic relationship between emotional and physical states: an observational study of personal health records. Neuropsychiatric Disease and Treatment, Volume 13, 411–419. https://doi.org/10.2147/ndt.s120995

Non-Opioid Treatment. (n.d.). Retrieved October 29, 2020, from American Society of Anesthesiologists website: https://www.asahq.org/madeforthismoment/pain-management/non-opioid-treatment/

Opioid Overdose Crisis. (2020, May 27). Retrieved October 29, 2020, from National Institute on Drug Abuse website: https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis#:~:text=How%20did%20this%20happen%3F

Piacquadio, A. (2018). Woman in Gray Tank Top While Sitting on Bed. In Pexels. Retrieved from https://www.pexels.com/photo/woman-in-gray-tank-top-while-sitting-on-bed-3807730/

Porter, J., & Jick, H. (1980). Addiction Rare in Patients Treated with Narcotics. New England Journal of Medicine, 302(2), 123–123. https://doi.org/10.1056/nejm198001103020221

Prescription Opioids. (2019). Retrieved October 29, 2020, from Centers for Disease Control and Prevention website: https://www.cdc.gov/drugoverdose/opioids/prescribed.html

Shipton, E. E., Bate, F., Garrick, R., Steketee, C., Shipton, E. A., & Visser, E. J. (2018). Systematic Review of Pain Medicine Content, Teaching, and Assessment in Medical School Curricula Internationally. Pain and Therapy, 7(2), 139–161. https://doi.org/10.1007/s40122-018-0103-z

Temma Ehrenfeld. (2019, April 30). Why People Are Choosing Acupuncture Over Opioids for Pain Relief. Retrieved October 29, 2020, from Healthline website: https://www.healthline.com/health-news/acupuncture-over-opioids-for-pain-relief

Understanding the Epidemic. (2019). Retrieved October 29, 2020, from Centers for Disease Control and Prevention website: https://www.cdc.gov/drugoverdose/epidemic/index.html