Call it human nature. When something goes wrong, we look for someone to blame. When a child gets in trouble, they are quick to point the finger at a sibling. When a product malfunctions, we sue the manufacturer. So it isn’t surprising that “Pharmageddon” would spark its own type of blame game.
Even though the U.S. government’s War on Drugs started more than 40 years ago, in many ways it has been reborn in new formats. Just as the problem of illegal drug abuse has been met by law enforcement with punitive penalties for nonviolent drug offenders, the prescription drug epidemic has provoked its own type of witch hunt.
Who is responsible? Who can be punished for allowing the nonmedical use of painkillers to take second place as the most prevalent form of drug use in America, even as the War on Drugs rages on?
In the past decade, there has been a 400 percent increase in admissions to drug rehabilitation centers for addictions to prescription pain relievers. We have seen a fivefold increase in hospitalizations and a fourfold increase in overdose deaths related to prescription drugs. Teenagers who used to experiment with illicit drugs like cocaine, meth or heroin now prefer prescription drugs like Vicodin and OxyContin.
We are hearing the alarm bells about prescription drug abuse, but the knee-jerk reaction has been punitive – more law enforcement, monitoring doctors and catching people filling too many prescriptions. Is this the new War on Drugs?
First, people blamed the addict for being morally flawed or weak and becoming dependent on a medication that wreaked havoc in their lives and on their families. Then research demonstrated that addiction is a chronic disease similar to heart disease and diabetes, which produces changes in the brain that make it extremely difficult to stop using drugs once addiction has set in. As it turns out, addiction is not the result of weakness or immorality.
Next, people blamed the family for falling prey to codependency, blaming or rejecting the addict, or not knowing what to do – and as a result, doing nothing. If only mom had locked the medicine cabinet or dad had educated himself about the signs of prescription drug addiction. While there are genetic and environmental factors that contribute to addiction, families cannot be held accountable for this widespread drug problem.
Another target for blame was the drugs themselves, along with the pharmaceutical companies who manufacture them. Prescription drugs have been a life-saver for people struggling with chronic pain and other health conditions. Like any medication, prescription drugs have benefits and risks, and pharmaceutical companies are working on new formulas that make certain drugs more difficult to snort or inject. In general, these medications are safe and effective when properly prescribed and taken as directed. Any approach to managing the prescription drug epidemic will have to balance the legitimate needs of people with medical problems with the risk for addiction.
If it’s not the drugs, maybe it’s the doctors who prescribe them. Faced with pressure from patients who can’t seem to overcome pain and other conditions, people argue that doctors, dentists and other health care providers prescribe more medication than is necessary. But the majority of doctors, who are put in the difficult position of trying to monitor patients who doctor shop or misrepresent their condition, abide by prescribing guidelines. While it’s tempting to point the finger at doctors, the National Survey on Drug Use and Health found that more than 70 percent of people abusing prescription drugs get them from a family member or a friend, not a doctor.
Certainly, there are unscrupulous doctors such as those running “pill mills,” pain clinics that provide large quantities of prescription painkillers, with little or no examination, to patients looking to feed their own addictions or sell the drugs for a huge profit. Most states have set up prescription drug monitoring programs to track prescriptions and prevent doctor shopping, but determined individuals continue to find ways to skirt the laws.
Most recently, war has been waged against online pharmacies. Anyone, young or old, can easily purchase prescription drugs on the Internet, often without a prescription. An estimated 10 percent of prescription drug users get their medications online. Because of the difficulty in targeting online providers of illegal drugs, which often operate overseas, efforts to regulate online pharmacies have been generally unsuccessful.
Perhaps it is the War on Drugs itself that is fueling the prescription drug epidemic. The government agencies we entrust to control the nation’s drug problem have been largely ineffective at reducing drug abuse. Rather than hunting down drug traffickers and violent criminals, they have spent the majority of the drug-control budget to pursue nonviolent, low-level drug offenders. Treatment and research have given way to an emphasis on law enforcement and punishment.
In a problem as complex as prescription drug addiction, there’s a good chance many parties play a contributory role. But is holding any one person or group accountable an accurate or productive way to address this epidemic?
Instead of approaching it from this direction, let’s focus on what we know works: education, treatment, research and prevention. If we directed our resources at destigmatizing mental illness, giving people more access to quality addiction treatment so they aren’t self-medicating with addictive drugs, and dealing with the root issues that cause people to want to check out with Vicodin, Xanax and other medications, we could put an end to the finger-pointing and finally make real progress in this War on Drugs.
David Sack, M.D. is board certified in Addiction Medicine and Addiction Psychiatry. He is CEO of Elements Behavioral Health, which includes the Promises rehab center, The Ranch in Tennessee, and The Recovery Place in Florida.
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Last reviewed: 12 Feb 2012