May 24th, 2018

Guest Column: Fight against opioid addiction must target the real risk factors

By Medicine Hat News Opinon on March 17, 2017.

On Sept. 28, 1980 The Washington Post ran an article written by reporter Janet Cooke. It began: “Jimmy is 8 years old and a third-generation heroin addict, a precocious little boy with sandy hair, velvety brown eyes and needle marks freckling the baby-smooth skin of his thin brown arms.”

“Jimmy’s World” won a Pulitzer Prize, which the paper ultimately had to return. Cooke had written pure fiction: no 8-year old heroin addicts could be found in Washington’s poorest neighborhoods, despite extensive searches. It appears in 2016-17 a large number of media outlets, regulators and policy makers have resurrected the need to recreate the time of the 1980s. Anyone reading a newspaper or watching television news reports today is exposed to the ongoing hysteria concerning the so-called “epidemic” of deaths due to prescription opioids. This epidemic agenda is not entirely new. And while it makes for sensational news headlines that grab public attention, the use of this term and its accompanying panic-provoking rhetoric might be akin to falsely shouting “fire” in a crowded movie theater and started a “Pied Piper effect.”

The typical dictionary definition of “epidemic” is a disease or condition “affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time” (Merriam-Webster online). We do have a problem of substance misuse in this country, but it is not a prescription medicine problem. In recent articles those, who should know better, have blamed doctors for the problem. This is blatantly false. They claim 75 per cent of addictions were the result of doctor prescribing, however according to the well respected and representative National Survey on Drug Use and Health, 75 per cent of all opioid misuse starts with people using medication that wasn’t prescribed for them —obtained from a friend, family member or dealer. And 90 per cent of all addictions — no matter what the substance — start in the adolescent and young adult years. Young people who misuse prescription opioids are heavy users of alcohol and other substances. This type of substance use, not medical treatment with opioids is by far the greatest risk factor for opioid addiction reports Richard Meich et al of the University of Michigan. Their research was analyzed data from the nationally representative “Monitoring for the Future” survey, which includes thousands of students. In general, new addictions are uncommon among people who take opioids for pain. According to a recent study by Dasgupta et al, of 2,182,372 patients prescribed opioids, 478 overdose deaths were reported (0.022 per cent per year).

It is sad when these ongoing “stories” much like “Jimmy’s World” continue to mischaracterize most of what is actually happening have destroyed the lives of people with pain. By reacting the way they have to these unfortunate tragedies, inflicted by the use of illicit fentanyl and other substances they have made the problem worse. Indeed, as with lessons learned from the Prohibition of alcohol, the consequences are only greater harm. Restricting the legitimate use of opioids drives patients to illicit substances, which are not only potentially contaminated and of unpredictable potency, but they also support crime. Addicts have never had their disease mitigated by the restriction of supply. Criminal suppliers always find the means to meet their demands, but I guess this is where the “head in the sand” approach will solve the problem.

If you want to reduce opioid addiction you have to target the real risk factors: Mental health, unemployment and child trauma. So to those who blame doctors you must do better and quit obfuscating what the real problem is. You should be working with other policy makers to create better mental health programs and then fund them properly.

Barry Ulmer is executive director of The Chronic Pain Association of Canada.

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