In 2011 a group of physicians descended on Capitol Hill to ask congress to help them fight prescription drug abuse. How? Finally require all health care professionals get real training in prescribing addictive drugs, recognizing signs of addiction, and identifying problematic patterns of use.
Most physicians receive little or no training regarding substance abuse and the use of controlled substances that have the potential for addiction. While there are many doctors who prescribe these powerful drugs responsibly, and these drugs are often critically important when used as intended (usually very short-term use or on an as-needed basis), better education will help them recognize drug-seeking behavior and train them to evaluate and refer these patients to treatment the same way they do when they see high blood sugar or blood pressure.
Some years ago a recovering addict with over five years clean and sober related to me a story about their doctor. They had been having some anxiety lately, and had been working on it through meditation, exercise, and nutrition, but still wanted the doctor to check if there might be something else contributing to what felt like sudden bursts of adrenalin: heart racing, sick feeling in the stomach, and shortness of breath. The doctor opined that it must be an anxiety attack.
“I’ll write you a prescription for Xanax,” the doctor told the patient. “Just take one when you feel an attack coming on.”
The recovering addict reminded the doctor that he is in recovery and cannot “just take one” when he feels like it. He would be taking “just one” all the time within a matter of days or weeks.
The doctor’s response was, “One pill isn’t going to send you back to the Garden of Eden.”
Fortunately this recovering addict understood what his doctor did not. ‘Just one’ is not possible for those with addiction. Anyone who has ever been addicted to a drug is 10 times more likely to become addicted again than the general population. My friend declined the prescription and changed doctors.
When we hear about celebrities like Michael Jackson and now Whitney Houston — people with a known history of substance abuse and stints in rehab — getting prescriptions for highly addictive drugs such as Xanax and Valium, we wonder why anyone would even consider prescribing these medications.
However, as long as physicians do not truly understand addiction (that it is a brain disease) and we do not give them tools to intervene when patients are in trouble (treatment is getting harder to cover with insurance), this pattern will continue. We cannot keep beating the drums of blame without creating mechanisms for change.
We often wonder about the family members and friends who wring their hands in despair when a loved one dies and drugs appear to be the cause. Did they really not know this was the potential end to the behavior?
The truth is denial can play a huge part in allowing dangerous behavior to continue. If the celebrity switches from illegal drugs such as cocaine or heroin to something prescribed, such as OxyContin or Valium, the family actually breathes a sigh of relief. They figure it’s prescribed so it must be safe. Nothing could be further from the truth.
Addiction is addiction. Where the drug is obtained (on the street or from the local pharmacy) and the reasons given as to why it’s “needed” (anxiety, insomnia) are really irrelevant once use has escalated to abuse.
I have actually heard of physicians who naively “help” alcoholic patients stay sober by prescribing them Valium to deal with their anxiety now that they aren’t drinking. It’s hard to believe a doctor doesn’t understand that they are just switching the drug of choice, but in fact many do not.
Mandatory education of our nation’s doctors, who by law serve as the gatekeepers of addictive prescription drugs, is long overdue. However, this should not mean we blame doctors for an addict’s behavior. Even if all doctors stopped prescribing addictive drugs, we would still have addiction. It’s a powerful disease, and the biggest obstacle that addicts who want to get better face is lack of access to treatment.
David Sack, M.D, is board certified in Psychiatry, Addiction Medicine, and Addiction Psychiatry. He is CEO of Elements Behavioral Health, a network of addiction treatment programs that include Promises Treatment Centers, The Ranch at Piney River, The Recovery Place, and The Sexual Recovery Institute. You can learn more about Dr. Sack at http://www.drdavidsack.com or follow him on Twitter at http://www.twitter.com/drdavidsack.
Doctor with prescription photo available from Shutterstock.
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Last reviewed: 16 Feb 2012