LET'S RETHINK FLAWED POLICY REGARDING SUBSTANCE ABUSE

Florida is being squeezed between for-profit pill mills serving
drug-seeking patients and citizens who exist in agonizing pain because
their physicians are reluctant to prescribe enough medication to
permit their patients to live in comfort. Meanwhile, politicians, who
lack expertise in either pharmacology or psychology, seek to exploit
this tragedy for political gain.

Florida loses seven people each day from the misuse of prescription
drugs. Even one needless death is a tragedy. What is to be done?

For one thing, we could re-examine the flawed public policy that some
drugs are bad because they are highly addictive and other drugs
(alcohol and nicotine) are acceptable because they are less addictive.
Current research indicates that all substances are equally addictive.

The end stage of chronic obstructive pulmonary disease is equally
unpleasant whether one used tobacco or pot. Some people can use
substances for years and never become abusers or addicts; other people
are adversely affected by small amounts of the same substances.
Substance abuse is not due to exogenous factors (outside the body) but
endogenous factors (inside the body). Denied one substance, addictive
persons merely seek another self-destructive drug.

This insight is particularly important for pain management. My late
wife was, for years, an intensive care nurse. She was caring for an
end stage cancer patient. The physician wanted to limit the pain
medication lest the patient get addicted. My wife said the patient had
less than two weeks to live. What difference did addiction make in
this case? Then the physician worried that increasing the medication
might suppress respiration. To which my wife responded, "And how would
that be an adverse reaction for this patient who is in agony? Why not
make her comfortable for her few remaining days?"

I believe the time has come to engage in a serious public discussion
on the broad subject of drug experimentation, drug use, abuse,
dependency and addiction. The current mind-set seems to suggest that
substance abuse would disappear if we could just get rid of the drugs;
however, a century-long love affair with prohibition criminalization
has not proved much of an answer.

The reason prohibition is a failure became clear to me early in my
professional life when I worked as a counselor in a Salvation Army
men's social service center. People, seeking to get high or wasted,
engage in risky, self-destructive behavior. One client drank kerosene
and chased it with buttermilk. Another client, who ironically had a
doctorate degree in chemistry, became deaf from abusing aspirin. He
eventually died from an aspirin overdose. Was banning kerosene and
aspirin the answer? Would taking rope off the market prevent youth
from seeking an auto-erotic high from near-strangulation and then
accidentally dying from asphyxiation?

Promising, new approaches to substance abuse are under development.
Recent advancements in brain scans can now make a fairly accurate
identification of addiction-prone individuals. Scientists can actually
see the human brain responding to substances in such a way as to be
predictive of addiction/abuse.

This kind of information means it is now possible to initiate
interventions that treat people most at risk for addiction. It also
means that people who are unlikely to become addicted can be
administered medications at levels that are adequate to control their
pain, thereby reducing the reluctance of many physicians to provide
effective pain management.

It is not enjoyable burying the corpse of a handsome young man who
died from an accidental overdose. It is also difficult to counsel
people who live with debilitating pain but cannot find a physician who
will take the risk to prescribe enough medication to control their
pain. Current policies neither benefit people with drug-seeking
addictions nor people who simply want to live a somewhat normal life
without crippling pain.

Rethinking the whole drug issue can provide justice and mercy for
all.