Prescription drug abuse is finally showing signs of stabilizing. Some believe this gradual decline is the result of government efforts to crack down on the abuse of prescribed medications. At first glance, this may seem to be so. It appears that the war against prescription drugs is heating up but so far, all it has done is punish those who legitimately need medication and drive addicts to riskier drugs like heroin. The following examples suggest that, as a nation, we still do not have the right attitude about addiction that will enable us to develop effective treatments and policies:
#1 Prescription Drug Monitoring Programs
Most states have a prescription drug monitoring program, a registry of every individual prescribed a controlled substance, which generates reports of suspicious behavior when a patient obtains prescriptions from multiple doctors or multiple pharmacies in a given month. These efforts, while well-intentioned, may deter doctors from prescribing medications for legitimate uses to treat people with chronic or severe pain. Fearful of a time-consuming investigation that could jeopardize their professional license and reputation, many doctors are no longer willing to prescribe painkillers even when there is clear medical necessity.
People who can no longer access prescription drugs aren’t likely to simply give up their drug habit. They find another drug, often one that is more dangerous. In recent years there have been reports nationwide of users turning to heroin even in areas that have not historically had a heroin problem.
#2 Drug Testing the Unemployed
Texas law may soon mandate drug testing for unemployment benefits recipients. Congress has declared that it will allow states to test people whose occupations regularly conduct drug testing. Anyone with suspicious answers to state questionnaires would be drug tested and lose their benefits if they fail. Other states have voiced plans to follow suit.
Not only is drug testing an ineffective way to combat addiction, it might actually increase certain types of drug use. Because some drugs are detectable days or weeks after use (e.g., marijuana), people may try to escape detection by using faster acting drugs and drugs that most tests do not detect (e.g., synthetic drugs), which also tend to be more harmful. Cutting benefits doesn’t make people with drug problems stop using drugs; it makes it more difficult for them to get help and return to productive employment.
#3 Tighter Controls on Painkillers
In January, an advisory panel to the Food and Drug Administration voted to tighten controls on painkillers that contain hydrocodone, including the most widely prescribed drug Vicodin. For example, refills of hydrocodone would require a new doctor visit and doctors wouldn’t be able to prescribe more than a one-month supply.
The problem with tightening controls on painkillers is the vast majority of people who take prescription drugs do not abuse them. By some accounts, less than 1 percent of people taking prescription painkillers for chronic pain without a history of drug problems become addicted. Thus, tightening controls is less likely to diminish the number of people getting hooked on painkillers than it is to deprive people in severe, chronic pain of needed treatment. Instead, patients may be switched to less effective drugs, have difficulty finding a doctor who will treat them, or be forced to pay more out-of-pocket if their insurance provider doesn’t cover monthly doctor visits.
#4 Reformulating Prescription Drugs
When the makers of OxyContin reformulated the drug to minimize abuse in 2010, the sudden unattractiveness of one of the most widely abused painkillers prompted a dramatic surge in heroin abuse. Onlookers expected OxyContin to lose its huge following, but few expected such a widespread shift to heroin. Yet studies show that’s exactly what happened.
The reformulation achieved an important goal: OxyContin went from being the primary drug of abuse for 36 percent of participants to just 13 percent less than two years later. But participants didn’t stop using drugs. Use of potent painkillers fentanyl and hydromorphone rose from 20 percent to 32 percent, and the number of people abusing heroin in the past month doubled.
Heroin is a dangerous and addictive drug and a much greater overall risk to public health than most prescription medications. Users have to take it more frequently, rarely know the purity of what they’re taking (which increases the risk of overdose), and often end up engaging in high-risks behaviors like needle sharing and criminal activity to fund their habit. What’s more, they’re out of touch with the medical system. Instead of dealing with doctors, they’re scoring from street dealers.
Addressing Demand, Not Supply
Changing supply does little to change demand when it comes to drugs of abuse. Why? Because addiction is a chronic brain disease that changes the function and structure of the brain, and because people often use drugs to cope with painful emotions. Neither of these problems is cured by making drugs less available.
People aren’t going to stop using drugs because we change the formulation. They aren’t going to quit because we create harsher drug laws. So what will work? Put simply, the same solutions that apply to other chronic illnesses: prevention, education (of patients, physicians and the public), and long-term disease management.
Instead of criminalizing addiction, encouraging doctors to stop providing care to people who may be addicted to prescription drugs, and focusing the majority of our research and resources on new formulations, vaccines and pills to defeat people’s attempts to get high, we need to address the deeper issues at work in addiction.
David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of mental health and addiction treatment centers that includes Promises, The Ranch, The Recovery Place, The Sexual Recovery Institute, Promises Austin, Right Step, Clarity Way, Journey Healing Centers and Lucida Treatment Center.
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Last reviewed: 8 May 2014