Thursday, November 12, 2015

Substance Abuse

Former Governor George Leader stated one of the most important lessons he wanted people to realize was, when he was Governor, which was a few years after I was born, 90% of the people institutionalized by the Commonwealth were in public health treatment and 10% were imprisoned. Today, 90% of the people institutionalized by the Commonwealth are imprisoned and 10% are in public health treatment.
During our lifetimes, we effectively made a public policy choice that we would take the vast majority of people experiencing health and social problems and, instead of providing treatment so they may overcome their difficulties, we throw them into prisons  and  jails. We did this incrementally without debating what we did. It is time we open these discussions.
Statistics prove this is exactly what we have done.  Data shows that 70% to 80% of people who are incarcerated are so a result of substance abuse. They were either selling or possessing illegal drugs, committed an offense to afford to purchase illegal substances, or they committed the crime while under the influence of an intoxicant.
Most of the people imprisoned for substance abuse are in their twenties. People at that age tend to do immature things. They usually become more mature, have jobs, form families, etc. in their thirties and beyond. Many people arrested in their twenties are given long prison sentences. In prison, they learn to become better criminals. While they are in prison, their children grow up without a parent. When they are released, the stigma of being a convict makes employment difficult.  Long prison terms for substance abusers does not solve many problems and create many new ones.
Granted, some career criminals or people who committed horrific acts deserve to be incarcerated. The vast majority, though, are people like you, the reader, or someone you know, who took too many prescription pills or had a few too many drinks and become dependent or addicted to drugs and/or alcohol, who  committed some offense and was caught.  A Federal government survey indicated that one fifth of all Americans self-reported they had an addiction problem at some point in our life.
The most expensive method to handle people with these problems is to imprison them. It costs you, the taxpayer, billions of dollars every year keeping these people incarcerated. It costs tens of thousands of dollars per inmate every year. Effective treatment may cost only a few thousand dollars and in some drug free treatments even less.
It would be far less expensive to treat the substance abuse. Providing arrested people with an alternative of completing substance abuse treatment instead of being incarcerated or even proceeding to trial would save lots of money.  More important, it would give many people healthier and more productive lives.
Substance abuse, in total, is the most costly health care cost. Estimates are that we provide treatment to approximately one tenth of substance abusers. There is no other major health care concern where we treat so few people.
We need to expand drug and alcohol treatment. We need to make substance abusers aware that treatment works, it is available, and we need to convince them to enter and complete treatment. This will take funding and outreach. The long term savings will be enormous. More important, many people will have improved lives.
Common sense states we should take our most expensive health care cost and treat it effectively. We instead treat substance abuse with the most expensive and least effective response, which is incarceration. It is time we use common sense and implement the correct treatment strategies towards solving our substance abuse crisis.

Opioid Crisis

A misreading of a journal publication has led to the greatest cause of death of middle age white males.
The leading cause of death of Caucasian males, aged  45 to 54, is drug overdose.  Since 2000, it has surpassed diabetes, chronic liver diseases, suicides, and then lung cancer to become what most kills middle aged white men. What makes this statistic even more frightening is that substance abuse is also associated with most of the chronic liver diseases and many of the suicide deaths. Added together, drugs are directly and indirectly, by far, the leading reason why a middle age white male dies.
This is strictly an American phenomenon. The death rates for middle aged white males has decreased in other countries, contrary to what is happening here. The reason is because we Americans consume far more prescription pharmaceutical drugs than do people outside America.
It is not just middle age white males dying from drug overdoses. It is just that this statistic sticks out. Any preconception that it is just “druggies” who are overdosing is wrong. It is estimated that 6.5 million Americans abused Oxycontin, a legally prescribed pharmaceutical, compared to there being 500,000 Americans using crack cocaine. It is estimated that one in four families have at least one member suffering from substance abuse. Substance abuse occurs amongst every demographic type of American.
One of the reasons why substance abuse affects every type of American is prescription drugs are over prescribed. This is making many people addicted or dependent upon these drugs. From high school students with bodily injuries to middle age people with back aches to older citizens with creaking joints, physicians have prescribed powerful drugs to handle pain. What many physicians do not realize is that these drugs are addictive.
The reason many physicians do not realize this is because they were told the drugs would not be addictive. This is where the misreading of a journal publication becomes critical. OxyContin was marketed to physician as an essentially non-addictive drug. It was claimed that only 1% of its users would become addicted. Physicians had no reason to doubt this and thus freely dispensed OxyContin and other pain relievers.
Physicians in fact were pressured to dispense pain relievers. During the early 1990s and before, physicians did not prescribe narcotics for pain. In 1992, there were organizations, heavily associated with pharmaceutical manufacturers, which began declaring there is a need for pain management. Physicians who refused to do this were ridiculed for allowing their patients to remain in pain. The concerns of Medical Associations that the pain medications could be addictive was handled by their successfully lobbying state legislatures to make physicians immune from liability should patients become addictive. Treating pain with narcotics has become standard practice.
Why would physicians knowingly prescribe medications even when they correctly feared were addictive? They did so because the drug manufacturers assured them that the drugs were safe. It turns out the basis for these claims was from misrepresenting a journal publication.
In 1980, the New England Journal of Medicine published a letter from a physician stating that, of 12,000 hospitalized under physician care, when given low doses of opiates, resulted in a one per cent addiction rate.
This letter was misinterpreted as a journal article (not a letter) stating that the use of larger doses of opiates (not low doses, as the letter stated) given to patients to take home (not in physician controlled hospitalization settings as the letter stated) would result in a one percent addiction rate (which still indicates a need to monitor for addiction being a result). It seems few, if anyone, checked if this was correct, in part because this journal was archived online only back to their 1993 issues.
The Federal government prosecuted the drug manufacturer that made this misleading claim. The case was settled for a $634.5 million fine. Still, the company continues selling OxyContin with annual sales over $3 billion annually.
As Oxycontin and other opioids continue being sold, people are dying from using them.  It is not just white middle age men but people of all kinds who are taking opioids for pain and dying from opiate overdoses. Some opioid users turn to heroin, another opiate which, while illegal, is actually often less expensive than legal opioids.
Opioid overdoses are rapidly increasing and have become a major cause of death for all age groups of both sexes. We need to act to handle this problem. We need to expand the number of drug treatment facilities. We need to convince more people abusing opioids to get treatment. We need to make more opioid abusers aware that treatment exists and is possible.
This leading health care crisis is solvable. It requires actions. We need now to do that which is necessary to save many lives.