War. What is it Good For?

“The older I got the more I realized that grandma wasn't just full of Christmas cheer, she wasn't just happy: Grandma was high! Seeing her medicine cabinet as a teenager was like discovering Shangri-La".

DISCLAIMER: THE MAJORITY OF THIS IS NOT PERTAINING TO PEOPLE RECEIVING TREATMENT FOR PAIN.

The so called War on Drugs wasn’t successful at accomplishing much except for the incarceration of black and brown people in disproportionate numbers. “Just say no”, wear a red ribbon for a week and focus on telling kids how bad drugs are, and run ads about your brain on drugs. Whatever, people kept using drugs and getting high. I once had someone tell me that they didn’t sell drugs, “drugs sell themselves”. People are abusing Immodium for crying out loud because they want to get high. And why was it dubbed a war on drugs? Why the adversarial stance against people using drugs? Society traditionally viewed people who use substances as outcasts, but now demonstrates compassion for people "forced" into addiction by clinical providers. This started in the 1980s, yet the US is still trying to figure out ways to prevent drugs from crossing our borders. It seems that it would’ve been more helpful to declare war on the lack of resources to treat underlying conditions that make people want to use drugs. 

Opioid crisis, #crisisnextdoor. The current US Surgeon General speaks to the need for increased funding for services to provide integrated treatment, including mental health services. Yet it seems that his sound logic is being overshadowed by the emphasis on the Opioid Crisis and access to Naloxone (Narcan). Please don’t misunderstand me, increased access to Narcan for overdose prevention is necessary. But let’s not loose sight of the real issue: prevention (and reduction) of use and overdose to begin with. In my experience, over 90% of the people I’ve treated for substance use had a diagnosable mental health condition;  people self-medicate in an attempt to feel better or to block out painful memories. This is where the word “treatment” becomes hazy. When they mention increased access to treatment as part of the solution to the current crisis, what exactly do they mean? True, many substance abuse programs provide mental and physical health services, but there are still some that don’t. And how are we increasing access to services amidst an attempt to cut funding for healthcare for those who have difficulty affording care?

And why are we wasting money trying to sue Big Pharma. "Why are they still making these drugs?" Because some people actually take them as prescribed to treat pain. People like to throw the term Big Pharma around in a negative manner without looking at the full story: they have been attempting to make medications that work as intended but with safeguards to prevent inappropriate use. Take Oxycontin for example. The manufacturer developed a version with a coating that couldn’t easily be crushed or dissolved for snorting or injecting. People tried it anyway, experienced adverse effects, and then wanted to blame the manufacturer. I’ll provide a more basic example:Tylenol. People took more than the recommended dose and experienced problems with their livers. You can’t buy the 650 mg strength anymore (part of the reason Vicodin is dead, Norco has less Acetaminophen/Tylenol). So is this Big Pharma’s fault or do people need to be held accountable for using medications incorrectly?

I encourage people to read about the Sunshine Act and Anti Kickback statutes regarding monetary incentives for prescribing (sorta boring but good information). It’s been over a decade since companies were able to provide items with logos or drug names on them. So I really need people to stop acting like all medical providers are so easily swayed by lunch or a few free trinkets that we are able to get at conferences. The overwhelming majority of us don't get paid for prescribing drugs. Or did they put my million dollar check in someone else's box? Anyway, when drugs are taken off of the market we end up with synthetic drugs which are more lethal in most cases.  And clutch my pearls! Suburban use of heroin is on the rise (I guess it’s a gentrification proof drug). Let’s pay attention to it now because people with money are using poor people’s drugs. But with most of the focus being on opiates and ads against underage use of tobacco, is everyone else unimportant? What about alcohol, cocaine (powder is popular again), meth, marijuana, nitrous oxide, ghb, shrooms, etcetera so on and so forth? Oh yeah, FLOTUS is on her job to help children Be Best by telling them to not use drugs and be resilient.