Is it Really Our Job To Save The Addict?

The problem

“Drug overdose was the leading cause of accidental death in the U.S., with 64,070 lethal drug overdoses in 2016. An estimated 53,332 have been linked to opioids of some type, which is an increase of 61% from 2015,” according to Nick Szubiak, Licensed Clinical Social Worker, National Council for Behavioral Health. He observes that the epidemic is partially being fueled by the early myth started by a letter published in New England Journal of Medicine in 1980 that opioids were non-addictive. In addition to that, there has been unrestricted prescribing of medications, and increase of availability and potency of less expensive heroin.

Dr. Lantie Jorandby, is board certified in addiction psychiatry. She is currently with the Amen Clinics in the Washington. DC area. Having been involved in Medical Assistance Treatment clinics providing suboxone and methadone within the VA system, Dr. Jorandby has observed, “egregious over-prescribing in the primary care setting in the VA system.” This over prescribing, she says, is usually done by “well-meaning” doctors, getting stuck in a cycle of prescribing dangerously high levels of opiates. She added “the system perpetuates when patients complain that their doctors want to stop their opiates, putting doctors in a bind with their jobs.” She has heard “reports of patients threatening doctors if they try to take them off of opiates, creating a perfect storm,” she says. Many people are prescribed a full 60 pill prescription, when a few pills would do the trick.

Perpetuating the problem

Explaining that the medical community has been trained to prescribe for longer periods of time like ten to thirty days, Carolyn Castro-Donlan, Ph.D. suggested that there might need to be a different type of training for prescribing medications. She has been working with addictions since the 80’s when she was a nurse. She is now a consultant, currently collaborating on Medical Assisted Treatment using suboxone for maintenance, detox or helping patients taper off opioids slowly.

She observes that one of the biggest problems is that prescription monitoring across states lines is inadequate and needs to be universal. Often, she says, this is how addictions can be perpetuated.

What we can agree on

They agree that there is way too much over prescribing of opioids, so perhaps we should find a way to train differently in this area and/or regulate how much can be prescribed and in what way. On this same issue, we should probably monitor prescriptions of opioids across state lines, as suggested by Castro-Donlan. It’s way too easy for people to drive from one doctor to the other to load up on pain meds with no way of tracking whether or not there’s an obvious problem.

Another thing most of the professionals agreed on was Medically Assisted Treatment using suboxone or methadone for people struggling with addiction. If we could develop treatment that involves time-limited withdrawal support, coupled with therapeutic support to address underlying issues, that there should be a way to do that. Carolyn Castro-Donlan, PhD emphasizes that the withdrawal symptoms won’t kill you, but she said it sure feels like they will when you are going through it, and it might just be the humane way to allow someone to quit.

We are bombarded with societal messages that we are not enough.

We need more money, a faster car, a slimmer figure, and stronger deodorant if we are to be acceptable and loved. We are sent messages that we should never be in pain or suffer in any way. Jorandby and Castro-Donlan also agreed that connecting to a spiritual source through meditation, prayer, and gratitude is an important place to begin to find our true worth as human beings. Mindfulness principles like meditation and gratitude have been shown through multiple studies to actually change the brain. So, while the addiction changes the brain and alters perception in one way, meditation and gratitude are scientifically proven strategies for emotional strength and growth. So instead of looking outside of ourselves for ways to escape from our problems and stressors, we build resilience from inside.

And more than anything else, they agreed that education for prevention should start early, and awareness for reducing stigma is vital. People do not seek treatment often due to fear and shame. We are not talking about the “dregs of society” if there is such a thing; we are talking about housewives who take their kids to soccer each week, high school students who get injured in sports, businessmen and women who work hard every day, who started out with pain meds and find themselves on that slippery slope, leading to hopelessness and destruction. “Addicts are not stupid. Neither are they weak, but rather highly intelligent,” says Rev. Dr. Wesley Shortridge of Bealeton, VA.

Where to start

I don’t necessarily think the conversation should focus on whether or not it’s a choice, or whether or not society is co-dependent, but rather what we can agree on.

We may not be able to save every person who struggles with substance abuse, but we can at least do what we can to lessen availability and move in a healthier direction. Reverend Shortridge says, “We need to build a society that doesn’t need it.” And beginning with the suggestions above, that most seem to agree on, might be a good place to start.

1. Prevention by training in mindfulness principles, beginning with even very young students.
2. Raising awareness and offering education to reduce stigma and enhance understanding.
3. Putting some regulations around prescribing practices to limit availability.
4. Offering limited and focused Medically Assisted Treatment, coupled with therapy, for the purpose of a better recovery.

---