Tackle the epidemic, not the opioids – Nature.com – Judith Feinberg – Sep 2019
This article is notable mainly for where it was published: in the respected journal, Nature, the “International Journal of Science”.
Since 2000, the US Congress has passed several bills to address this opioid epidemic. All of these efforts have specifically targeted opioids. And that is part of the problem.
Historically, substance misuse has come in waves, with a new drug supplanting the previous one: the ‘heroin chic’ of the 1990s followed the ‘crack babies’ of the 1980s.
By the time federal programmes target a specific drug, the issue is being attacked where it was, not where it is. Funding should be targeted to substance misuse, not to the drug du jour.
The current opioid epidemic is a symptom of the fraying of the socio-economic fabric of the rural United States.
This is behind the rising rates of drug addiction and suicide. Too many people find it impossible to be “successful” in our capitalistic society and come to believe they have nothing to lose. This then leads to “abberant behavior”, like addiction and theft to support it.
The epidemic arose in the 1990s in areas that had experienced economic decline, a brain drain and population loss over decades. Many factors combined to create a monstrous situation in which small towns were flooded with prescription opioids.
Where I work in central Appalachia (West Virginia, southern Ohio, eastern Kentucky and northeastern Tennessee), opioids are being rapidly supplanted or exacerbated by cheap, readily available, high-potency methamphetamine.
When opioids are used, they are being increasingly combined with stimulants such as cocaine — which, like methamphetamine, is thought to help to counteract the depressant effect of opioids.
Many types of illicit drugs are being manufactured to be more and more potent, not just opioids. And because opioids can be sedating if they’re not counteracting pain, it makes sense to add amphetamines. (so you can stay awake to enjoy the high?)
Federal grants come tagged for combating opioids and cannot be repurposed to deal with the rising incidence of methamphetamine misuse.
This is the foolishness of our drug policies. By assuming the drug is the problem, it looks sensible to step up enforcement (of cartels and gangs, not doctors and patients) and/or set up treatment and other services for people taking that drug.
Politicians have a very short memory and don’t seem to recall all the previous drug scares: crystall meth, cocaine, marijuana, etc.
Even more neglected are efforts to understand why the rural United States is vulnerable.
Why is attention focused on this drug or that drug, when the real question is why is there a raging epidemic of addiction?
Without an effort to rebuild the social and economic fabric of rural communities, addiction will persist. That’s where the real problem lies, and as yet there are no serious attempts to address it.
Taking pain relief away from patients is a senseless practice that has no effect on the real problems that are causing other people to fall into addiction.
Our current approach to drug misuse means that we will always be playing catch-up and leaving vulnerable people behind.
Author: Judith Feinberg is a professor of behavioural medicine, psychiatry and infectious diseases at West Virginia University in Morgantown