The negative stigma of addiction is hampering effective treatment

Our country faces some serious problems today, as it has throughout its history. One of the most serious, one that claims the lives of thousands of Americans each year, is death from opioid overdoses.

This comes as no surprise to most of us, but perhaps the scale of the problem and the difficulties faced in addressing it might surprise many of us.

Facts about opioid abuse:

** In 2016 opioid overdoses killed 13 of every 100,000 people across the nation.

** America makes up about 4 percent of the world’s population but accounts for 27 percent of the world’s drug overdose deaths.

** On average, 175 Americans die every day from overdoses.

** Someone dies every 8 minutes from an opioid addiction.

** Overdoses kill more people than gun violence or car crashes.

** In 2017, more people died of an unintended drug overdose than in the entire 20-year Vietnam War conflict.

** Opioid prescriptions dispensed in 2006 were about 213 million, but rose to a peak of more than 250 million in 2012, before returning to 2006 levels four years later.

Where do people get these dangerous drugs?  Most get them from friends or relatives, but the Centers for Disease Control and Prevention tells us that those at highest risk of overdose are as likely to get them from a prescription issued by a physician.

Illegal drugs sales are also an important element, and synthetic drugs like fentanyl and other super-potent opioids pour into the U.S. through international mail and private carriers, the U.S. Customs and Border Protection reports.

Obviously, better control of legally dispensed drugs is needed, and stronger enforcement of drug laws is a must. But the other side of this coin is the way drug addicts are treated medically, and much work needs to be done there, too.

Treatment of addictions is difficult, and made more so by obstacles to using treatments effectively. Not the least of these is that our healthcare system regards addiction as a mental health problem, not a physical health problem, and the two are treated differently. Mental health problems have a lower priority than physical health problems, and therefore are underfunded, under-treated and less actively researched.

Given the lower priority, it is not surprising that the treatment protocols are antiquated. While the recent frightening increase in addiction and addiction-related deaths has brought long-needed attention to the problem, there is much to do in using available methods and effective drugs to maximize effective treatment. Surprisingly, abstinence programs and programs similar to Alcoholics Anonymous do not work well with opioid addiction.

The reality is that most people with addictions are not receiving any medical treatment, and many or most of those who are being treated are not receiving the most effective care.

According to the Substance Abuse and Mental Health Services Administration, only about one in ten people with a substance use disorder receive any type of treatment.

In his most recent book, Trump’s America,Newt Gingrich, in a chapter titled “Let’s Trump Addiction,” explains that there is a better way to treat the drug addicted. “The research is unequivocal that behavioral therapy combined with recovery medications, such as methadone, buprenorphine, and Suboxone, is the most effective way to treat opioid addiction.” This type of treatment, studies show, can reduce the mortality rate of drug-addicted patients by half or more.

Strangely, despite the strong support for this type of treatment, fewer than 3 percent of treatment programs offer all three of the effective medications available to fight opioid addiction.

Gingrich comments, “This is a problem because each of the three recovery medications in the market has its own benefits and drawbacks. There is not a one-size-fits-all opioid addiction medication.”

He cites examples of the “simple bias” against mental health issues being applied to physical health problems, noting that these barriers would be “absurd, illegal and unethical” if applied to physical health problems. But they are somehow acceptable when applied to addiction and other mental health problems.

Both insurers and Medicaid have not yet realized that their current approach to treating addiction actually prevents the most effective treatments for these problems because they interfere with the use of the three medications. Or, if they have realized it, they have not yet removed those barriers.

Doing so would save thousands of lives – which is the most important outcome – but they would also save millions of dollars that are now spent on the drug addiction problem.

Citing the Surgeon General’s Report, Gingrich explained that every dollar we invest saves money, listing these findings:

** $1 for brief primary care addiction intervention saves $27 across the system;

** $1 for addiction intervening at a hospital saves over $36 or $9 in the emergency room;

** $1 for treating substance abuse saves $4 in overall health care costs, and $7 in criminal justice costs by preventing the cycle of recidivism that often accompanies addiction.

Many people view addiction as something other than a disease, but Gingrich summarizes this chapter by saying, “Addiction is not a moral failing or a lack of strong will. It is not a choice, it is a disease.” That negative stigma plays a significant role in hampering effective treatment.

Corporate deep pockets attract attention in legal actions

Millions of Americans hate big corporations, suspect them of acting in their own best interest, to the detriment of the rest of us, and delight in corporations being put in their place. Sometimes they have good reasons for this; sometimes not. But let’s face it: legal actions against these corporate giants are sometimes justified, and give people harmed by a product or action of a corporation deserved monetary compensation.

With that in mind, this item from farmfutures.com tells about “Lee Johnson, a former school groundskeeper whose doctors didn’t think he’d live long enough learn the verdict, prevailed Friday in San Francisco state court after jurors deliberated for three days” on his damage suit.

The story went on to say that the “trial was an important test of the evidence against Monsanto and will serve as a template for litigating thousands of other claims” over Monsanto’s Roundup herbicide.

Johnson got less than he was asking; being awarded only $39 million of the $412 million he sought in damages. An additional $250 million was added to punish Monsanto after finding it liable for a design defect and failing to warn consumers of Roundup’s risks. Monsanto has said it will appeal the award in this the first trial over claims that the Roundup weed killer causes cancer.

Roundup is the world’s most popular and widely used herbicide, and its main ingredient – glyphosate – was approved for use way back in 1974. Monsanto defends the ingredient as perfectly safe, however, a cadre of opponents of glyphosate that includes environmentalists, regulators, researchers, and lawyers, hotly challenge that claim.

The Wall Street Journaladded some important information to this story. An editorial described the plaintiff’s attorneys’ approach to persuading the jury of Monsanto’s responsibility in Johnson’s cancer, as “junk science.”

The Journalwent on to explain that “the problem … is that there’s overwhelming scientific evidence that glyphosate does not cause cancer,” and quoted the Journal of National Cancer Institute study of 45,000 licensed pesticide applicators exposed to glyphosate which found “no evidence of an association between glyphosate use and risk of any solid tumors or lymphoid malignancies including non-Hodgkin lymphoma.”

The editorial further cited the Environmental Protection Agency as concluding that glyphosate is safe. “In December 2017, the US Environmental Protection Agency released the draft human health risk assessment for glyphosate, the active ingredient in Roundup,” according to North Carolina State University’s Patrick Maxwell, M.S. and Travis Gannon, Ph.D. “The human health assessment concluded that ‘glyphosate is not likely to be carcinogenic to humans’ and found ‘no other meaningful risks to human health’ when used in accordance with label instructions,” they wrote.

This seems to be a classic case of “he said, he said.” Both sides have advocates with solid credentials who advocate each position.

Sometimes, however, emotions trump factual evidence. And who isn’t sympathetic to Lee Johnson, whose cancer may end his life early. And there is also the factor of which legal team did its job best.

But then there’s the very real factor that big companies have deep pockets, and therefore are prime targets. A good example of this is the current rampant overuse of drugs, and the blame often being laid at the feet of Big Pharma.

Pharmaceutical companies’ business is identifying serious medical problems affecting lots of people, and working to develop drugs to help them, not to hurt them, and our government has implemented a long, slow process to require drugs to meet strict Food and Drug Administration (FDA) standards before they are approved for use.

Even the government, however, cannot prevent the misuse of items for sale, and virtually everything can be dangerous under the right circumstances. Step ladders, baseballs, automobiles are all sometimes dangerous.

It also cannot guarantee that drugs might not end up in the hands of someone who is allergic to one or more of them. People are allergic to milk, vitamin C and sunshine, and nearly everything else.

A single drug getting to market on average results from100 or more formulas developed for testing. Promising formulas must get through a process that takes on average 12 to 15 years, and costs one-to-two billion dollars. And they only get patent protection for a maximum of 20 years from the time it is applied for, which frequently occurs early in the testing process.

This leaves a relatively short time to recoup the sky-high research costs, so that the company has money to invest in finding the next needed drug.

Why would companies send out millions of doses of an expensive product, as they are accused of, without someone ordering and paying for it? Yet, state attorneys general and other attorneys are suing drug companies, blaming them for the drug epidemic.

It seems more reasonable to look at prescribing physicians, drug distributors, and outright criminal conduct for how and why these drugs are available to people to use them improperly, resulting in much suffering and needless death.

All of which is not to say that large companies don’t sometimes do things wrong. And when that happens, they should be punished.

But they should not be an automatic target of lawsuits, as they often are.

Getting it right in the battle against opioid overdose deaths

According to the Centers for Disease Control, Alabama, Tennessee and West Virginia – in that order – lead the nation in prescriptions for narcotic painkillers. Nationwide, there were close to 60,000 deaths in 2016 from drug overdoses.

How is this possible, when narcotics are strictly controlled? A popular target for blame for this problem is the pharmaceutical industry, which is often the focus of criticism. “We would not have a drug problem if manufacturers weren’t trying so hard to sell them,” the reasoning, such as it is, goes.

But making and selling drugs is what drug manufacturers do: they spend millions or billions of dollars over a decade and often longer to find the right formula to create a product that will help people suffering from a medical condition. They work to get the product through lengthy clinical trials and the stringent FDA approval process. Then, they must sell enough of that product during the patent protection period to recoup the costs of its development so the company can invest that money in another product’s development.

Also understand that drug companies do not provide addictive drugs to individuals, neither the legal users, nor the illegal users. They provide them to distributors, or directly to pharmacies, and unless someone steals them or distributes them improperly, they will contribute not one bit to a drug problem.

Far too many prescription drugs do get to users through “pill mills,” and some physicians who don’t have sufficient information about the effects of some drugs as they need may, as a result, over-prescribe them. And, obviously, these problems must be addressed.

However, a recent Daily Signal article tells us that the painkiller abuse problem is not primarily caused by prescription drug abuse and misuse, although the news we hear might convince many of us that drug companies are at fault.

The article, written by former director of the Office of National Drug Control Policy, Bill Bennett, who is also a former U.S. Secretary of Education, and Robert L. DuPont, MD, president of the Institute for Behavior and Health, explains that of the 60,000 deaths in the U.S. in 2016 from drug overdoses, 33,000 of them were opioid related.

And, they add that our news media mistakenly focus more attention on prescription drugs, instead of the illegal ones. Is that because Big Pharma is an easy and popular target?

Bennett and DuPont, in fact, say, “nearly 70 percent of our nation’s opioid deaths do not come via prescription abuse.” “The main problem today, and the growth for tomorrow,” they say, “is illegal opioids such as heroin, illegal fentanyl, and a hundred other synthetics, not legal drugs used illegally or in ways not as prescribed.”

They cite data from the Obama administration’s press office in 2015 saying that there were 33,091 opioid overdose deaths, 12,990 of which were from heroin. Another 9,580 were from synthetic opioids, mostly illegal fentanyl.

They propose a two-phased attack on the problem. First, fight harder against illegal drugs coming into the U.S. through better border enforcement to stop the drug traffic from and through Mexico, as well as working to have Mexico eliminate its poppy crops; have stricter monitoring of international mail services; and crack down on cartel activity, both here in the U.S. and at their source.

The second phase acknowledges that most money directed at the problem goes to “treatment, recovery, and urgent overdose reversal,” which they say is certainly important, but it is not enough. “We need to improve engagement in treatment, reduce dropout, and address the far too common outcome of relapse with sustained recovery—meaning no use of alcohol, marijuana, or other drugs,” by recovering addicts.

“But the main unaddressed nature of the opioid crisis,” Bennett and DuPont say, “is focus and energy on prevention.” This includes serious efforts to educate the public about what is in their medicine cabinets and how to keep those drugs out of the hands of those for whom they aren’t prescribed, and to educate the public about the dangerous nature of the drugs sold on the street. It is critical to also work to counteract the youthful use of alcohol, marijuana, tobacco and other drugs, where they say 90 percent of addictions begin.

Citing the rising death toll from illegal drugs, which they note is much greater than the crack cocaine problem in the 80s, the authors call for more effective action by political leaders, parents, the entertainment industry and health care professionals.

Looking back to the late 1970s and 1980s Bennett and DuPont recount how the nation conquered the serious drug problems of that time. “The nation rolled up its sleeves, went to work, talked about it, taught about it, and reversed it—and by 1992 we had cut drug use in half, and even more in some age groups.”

This problem is entirely preventable, and certainly can be dramatically reduced. “In sum, let us commence a strategy to stop the problems of abuse before they start,” they wrote. “It will take a nationwide effort, from the president’s bully pulpit down to local community messaging.”

Certainly, focusing on the real problem will produce positive results.