ADDICTION IS NOT A MORAL ISSUE

'Heroin is killing our kids." This has been the headline on the
South Shore and in the Northeast for too long!

Opiates are the leading drug problem in the Northeast and it is the
only region in the country where this is so.

Providing Narcan to an addict is a tool, it is an emergency measure
to treat an overdose for themselves or someone else. No addict wants
to be given Narcan.

Working in the field of addiction at Boston Medical Center, I have
yet to see a person who was still responsive hear the word "Narcan"
uttered and not try to flee the situation. When Narcan is
administered, it displaces the opiate from the receptor in the brain,
making the person physically ill, and reverses the respiratory
depression that causes the overdose.

When someone is addicted to opiates they spend their day trying to
keep from becoming sick. Over time, their body has developed a
tolerance and without the opiate they are "dope sick" and with the
opiate they feel "normal." It is a vicious cycle that many struggle
with day in and day out.

So, we say: Just stop, go to detox, put the drug down and get on with
your life. Why do we need Narcan, and why do we care what happens to
people who make a conscious decision to use opiates and potentially
overdose and die?

Because addiction is a disease, it is a brain disease and we need to
treat it much like we do other chronic diseases. We arm diabetics
with sliding scale insulin, perform repeated limb amputations, we
give chemo to the lung cancer patient who goes outside and smokes
cigarettes between treatments, we resuscitate the obese,
hypertensive, cardiac patient and perform open heart surgery multiple
times, we treat the alcoholics' GI bleeding, and cirrhosis.

But we continue to treat the patient struggling with opiate
dependence differently believing that because they are "addicted,"
they made the choice to be "addicted." The obese patient, the
uncontrolled diabetic, the cardiac patient and the alcoholic, they
have a disease much like the addict; it is a chronic disease and it
affects the brain. Science has proven this and yet society continues
to look at it differently.

Initial drug use is voluntary, however once addiction develops this
control is disrupted and it is no longer a choice to use, it is now a
chronic relapsing disease caused by prolonged effects of drugs on the
brain.

Prevention, education and treatment are all critical components in
the process, but what about those already addicted and not at the
stage of change where they are willing to put down that cigarette, go
on that diet, exercise or stop using drugs? Do we forget them and
move on? No, we meet them where they are at in their stages of
change, providing them with tools, education, treatment and support.
We meet people where they are at and hope over time they will move
forward and get the treatment they need for their disease.

Time is critical when someone overdoses, and having Narcan available
for that immediate response before medical help is sought can be the
difference between life and death.

It is critical to view addiction as a brain disease and understand
the brain has been altered and this drives the behavior of addiction.
Therefore, treatment is required to deal with the altered brain
including addressing behavior and the social components of the
illness. The management of a chronic disease is lifelong; it is a
chronic illness for which there is no cure.

We need to help folks change their behavior, and move forward in
their recovery process but this takes time, lots of hard work and
commitment. Changing behavior is not an easy task for anyone. How
many stick to their New Year's resolution and stop smoking, stop
drinking, eat healthier or exercise? It's not easy.

Providing Narcan to addicts or others for emergency measures will
save lives! Addicts are not going to use because they know there is
some Narcan in their pocket. Giving them Narcan will not replace
treatment but it will give them a tool to treat their disease should
they need it until such time that they are willing and able to engage
in treatment. It saves lives!

Heroin is killing our kids, it's impacting our community, and we need
to make a commitment to use whatever tools and resources we have in
treating this disease!

"How many deaths will it take til too many have died?" Peter, Paul,
and Mary.

Colleen LaBelle, RN, is the nurse program manager for the
office-based opioid treatment program at Boston Medical Center. She
lives in Hanover.