Do We Want Opioid Addicts To Recover -- Or Do We Just Want To Punish Them...With Horrible Suffering And Death?
If we want to help them, this, from an ABC News piece, seems to be a step in the right direction:
"Walgreens to offer drug naloxone, which can reverse opioid overdoses." In 8,000 pharmacies across the country -- available OTC.
From the piece:
"This is an incredibly safe and effective medication," ABC News chief medical correspondent Dr. Jennifer Ashton said today on "Good Morning America." "We've been using it in the hospital for decades, usually with a needle, intravenous or in a muscle."Narcan works to counteract respiratory depression, in which a large dose of opioid stops the body's signals to continue breathing. Overdoses from prescription painkillers, heroin and its derivatives cause this frequent cause of overdose death.
AmerisourceBergen, a pharmaceutical wholesaler, has distributed Narcan demonstration devices for free to Walgreens pharmacists so they can instruct patients on how to administer the medication, Walgreens said in a statement.
Meanwhile, a highly-effective treatment for opioid addiction is still being held back -- because it doesn't fit with the "cold turkey" model that the punishment-oriented believe should be in place.
At Vox, German Lopez writes that "medication-assisted treatment" is considered the "gold standard" for helping people pry themselves out of opioid addiction, but much of the country has resisted it:
Various studies, including systematic reviews of the research, have found that medication-assisted treatment can cut the all-cause mortality rate among addiction patients by half or more. Just imagine if a medication came out for any other disease -- and, yes, health experts consider addiction a disease -- that cuts mortality by half; it would be a momentous discovery."That is shown repeatedly," Maia Szalavitz, a longtime addiction journalist and author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, told me. "There's so much data from so many different places that if you add methadone or Suboxone in, deaths go down, and if you take it away, deaths go up."
That's why the biggest public health organizations -- including the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, and the World Health Organization -- all acknowledge medication-assisted treatment's medical value. And experts often describe it to me as "the gold standard" for opioid addiction care.
...One catch is that even these medications, though the best forms of opioid treatment, do not work for as much as 40 percent of opioid users. Some patients may prefer not to take any medications because they see any drug use whatsoever as getting in the way of their recovery, in which case total abstinence may be the right answer for them. Others may not respond well physically to the medications, or the medications may for whatever reason fail to keep them from misusing drugs.
This isn't atypical in medicine. What works for some people, even the majority, isn't always going to work for everyone. So these are really first-line treatments, but in some cases patients may need alternative therapies if medication-assisted treatment doesn't work. (That might even involve prescription heroin -- which, while it's perhaps counterintuitive, the research shows it works to mitigate the problems of addiction when provided in tightly controlled, supervised medical settings.)
Medication can also be paired with other kinds of treatment to better results. It can be used in tandem with cognitive behavioral therapy or similar approaches, which teach drug users how to deal with problems or settings that can lead to relapse. All of that can also be paired with 12-step programs like AA and NA or other support groups in which people work together and hold each other accountable in the fight against addiction. It all varies from patient to patient.
Walgreen's link from author Amy Dresner, who wrote the darkly hilarious, moving, and insightful addiction memoir, "My Fair Junkie."
I think part of the reason that people are doubtful about the medicine-assisted approach is the spectacular failure of methadone clinics in the 1970s. Looking back, though, there were probably two things that broke that: some people were overly optimistic about what methadone could accomplish, and too many clinics went with the "take this and go away" approach to administering it. I think the industry is smarter than that now.
Having said that, it still seems to me that most of the medical industry is very weird about opioids. A lot of doctors seem to fall into one of two camps: the ones will will prescribe willy-nilly, and the ones who will never prescribe at all and will chide their patients for asking about it. I've seen some articles by prominent doctors where their method for treating patients with chronic pain is to tell them, in effect, "you should just ignore it". That's like telling someone with chronic depression that they should just "snap out of it". The human body is designed to make pain difficult to ignore; that's why we call it that.
With terminally ill patients, I don't see what the big deal is with accepting that they are going to become addicted. After all, they're going to die anyway, and if opioids allow them to live their remaining year or so of life in comfort, then what's the harm? That they're setting a "bad example" for other people who are about to die? C'mon man.
Patients who aren't terminal but do suffer from untreatable chronic pain are a more difficult case, but it's not unresolvable. It's a matter of finding that right dosage that alleviates their pain (at least most of it) without turning them into zombies. (Keeping in mind that the body develops tolerances to opioids, so it is necessary to switch drugs periodically.) Would we rather have them buying heroin of unknown composition on the street, and taking it without a doctor's supervision? There are some doctors who need to get over themselves. Addiction will be more of a problem with these patients, but the fact that they are addicted is itself no big deal. The problems are the buildup of tolerance, the effects on consciousness (in regard to e.g., driving), and the emergency that occurs if the patient is cut off from their supply for some reason. These are all problems, but they aren't unsolvable, and it doesn't credit the medical industry when it just throws its hands up and says "the problem is too hard, we give up", or worse yet, "we don't want to cross the government, so we'll be good toadies and not say anything".
If the people who are demanding that opiates be banned or severely restricted were serious, they'd be demanding a huge increase in funding for chronic pain research, and easing of some of the FDA standards for alternatives to opioids. It doesn't help that the FDA keeps banning NSAIDs that could be an option for some opioid patients. I used to work with a lady who had severe rheumatoid arthritis. She suffered for years, scarcely able to drag herself out of bed and go to work. Vioxx gave her her life back. Then the government took it away again.
Cousin Dave at October 27, 2017 6:35 AM
In places where weed is legal, opioid use is down, and fewer people die.
Just sayin'
Steven Daniels at October 27, 2017 9:16 AM
"This is an incredibly safe and effective medication... Narcan works to counteract respiratory depression"
They make it sound like there's no downside, like it goes to work directly on the lungs to restore breathing. It's useful stuff but it's not all that rosey.
Narcan has side effects. It blocks opioid receptors - everywhere, not just in the lungs - and it does it very quickly. The result in an opioid addict is rapid onset of withdrawal symptoms, i.e. instant dope sick. Whatever pain was being relieved with opioids comes back in spades. It also blocks the effects of endogenous opiates, i.e. endorphins, part of the body's natural pain relief and pleasure system.
Also it lasts about 45 minutes, give or take about 15. Heroin lasts about 4 to 5 hours. So if someone is using Narcan to treat a heroin overdose they might need to take it more than once, or twice, or three times.
The first time I dealt with this, about 22 years ago, it was very annoying. A young woman who accidentally OD'd on heroin went from being unconscious and breathing six breaths a minute and declining - to being awake, pissed off and dope sick - and then back to unconscious and breathing eight breaths a minute and declining - in about 45 minutes. We gave her the naloxone three times. She wasn't happy about it.
Ken R at October 27, 2017 11:15 AM
Alcohol is a pretty effective pain reliever. In countries like Japan which are death on opoids, there is a very high rate of alcoholism.
Go to the dentist here for an extraction, they hand you two tiny ibuprofin on the way out the door. No wonder everyone drinks.
Isab at October 27, 2017 11:34 AM
I was assured victory in the war on drugs is just around the corner.
MarkD at October 27, 2017 12:51 PM
> In places where weed is legal,
> opioid use is down, and fewer
> people die.
This is not a small effect.
Crid at October 27, 2017 2:20 PM
Good timing.
I'm reading 'The Watchman's Rattle' by Rebecca Costa and she addresses a lot that's involved in this sort of thinking - the desire to blame the individual and/or apply simplistic solutions in the face of complex large-scale problems, for starters.
If I come up with a solution I'll let you know ...
Gog_Magog_Carpet_Reclaimers at October 28, 2017 10:02 AM
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