This week was the annual Conservative Political Action Committee conference, or CPAC. It has been happening for years, but this year President Trump spoke at the conference.
I spoke to some college students who attended CPAC, and we talked about the Mexican wall that President Trump has proposed. Then I asked them about the opioid problem in the U.S., and one of the students said he was in recovery from opioid addiction. They all agreed that it is now a very large problem in the U.S. They were concerned that the proposed wall might not keep drugs out of our country, as the drug traffickers are smarter than a wall and traffickers will find other ways to bring drugs into the U.S.
The problem is not just the drug traffickers; it is also demand. Cigarette smoking has been reduced in this country. Not only is it not OK to smoke inside of buildings, but things that were considered proper and cool 50 and 60 years ago, such as having cigarettes on the table at a dinner party, are not considered OK now. The public health community focused on reducing the demand, and it has been fairly successful in reducing demand, although some people still think it has a long way to go. In 2005, cigarette smokers made up about 21 percent of the population. By 2013, it had dropped to 18 percent of the population. That is still too high, but clearly progress has been made. In 1965, the smoking rate was 42.4 percent among people 18 years and older in the United States.
The public health community attacked smoking, but now it must focus on opioids. In 2014, before a Senate Committee, Nora D. Volkow, M.D., testified about opioid addiction. She said in her testimony: "The abuse of and addiction to opioids such as heroin, morphine and prescription pain relievers is a serious global problem that affects the health, social and economic welfare of all societies. … An estimated 2.1 million people in the United States are suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 are addicted to heroin. The consequences of this abuse have been devastating and are on the rise. For example, the number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999. There is also growing evidence to suggest a relationship between increased non-medical use of opioid analgesics and heroin abuse in the United States."
We know that patients visit emergency rooms with "drug-seeking behavior" regularly. We also know that the price of street drugs is often lower than the prices people pay in pharmacies. There are other ways that demand can be reduced as well. Dr. Volkow also said, "Research has shown methadone- and buprenorphine-containing medicines, when administered in the context of an addiction treatment program, can effectively maintain abstinence from other opioids and reduce harmful behaviors; we believe their gradual onset and long duration contribute to this ability to 'stabilize' patient behavior."
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The operative words here are "being administered in the context of an addiction treatment program." People like to be with people they feel are similar to them in terms of life experiences and values. It is why CPAC is so successful. People can share common experiences and values.
Treating patients who have an addiction is no different than political or social gatherings. People want to share their experiences. A single medical practitioner giving out buprenorphine medications can't make up for a program that treats addictions.
People need to share experiences. People need to see that someone else has "made it" and does not need to rely on a drug. I have two physician friends: One of them believes in prescribing buprenorphine, and the other is adamantly opposed. Both work in addictions.
No matter which physician is right about the treatment of addictions, the fact is that we must do something to control demand. One way is to educate the public in the same way that cigarette smoking was curbed. The other is to educate physicians so they can recognize drug-seeking behavior. Lastly, we need more treatment programs and more half-way houses where people can work but live in a supportive community.
It is going to take a concentrated effort to stop the opioid addiction that we see burgeoning in the United States right now. More than a wall is needed. Opioids are not only increasing crime, but they are ruining individual lives and families. It is perhaps the greatest public health issue of our time.
Media wishing to interview Ellen Ratner, please contact [email protected].
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