Saturday, March 27, 2010

Want to talk about the real drug problem?

So when are we going to start talking about the real drug problem in this country? A new issue brief from the CDC on “unintentional poisoning” (that’s what we’re calling drug overdose these days, especially when it involved prescription medication) reports that, in 2006, overdose was the second leading cause of unintentional injury deaths after motor vehicle accidents! 26,400 people died from overdose that year. Even more alarming are the rapid rates of increase --- overdose deaths have increased 5 fold since 1990. What drugs are killing people at such alarming rates? According to the CDC: “the increase in drug overdose death rates is largely because of prescription opioid painkillers.” There has been a ten-fold increase in the ‘medical use’ of painkillers in the past 15 years, and prescription opioids were responsible for more deaths in 2006 than heroin and cocaine combined.

There is no way to address the epidemic of prescription drug abuse with answering hard questions about who is using these drugs (largely middle-aged, white people), who is prescribing these drugs (doctors), and who is profiting from the sale of these drugs (Big Pharma). According to a market industry report, “the global market for pain management pharmaceuticals and devices amounted to $19.1 billion in 2008 and is expected to increase to $32.8 billion in 2013.” That’s a lot of incentive to prescribe opiates. Under the 1914 Harrison Narcotic Act, doctors cannot prescribe narcotics for the treatment of addiction, but they can and do prescribe it for pain. So, we have a set of policies where doctors can, for example, prescribe methadone (an opiate the causes physical dependence) for pain but cannot prescribe it (except in a few highly regulated clinics) to treat addictions. Just to reiterate, doctors can prescribe the medications that cause addiction, but once people are addicted, both addicts and doctors are trapped in a difficult dance over if and how medications will continue to be prescribed.

This confusion in our policies has created a cottage industry of pain management clinics, particularly in states like Florida with less regulation (try googling Florida + pain management). For sure, many people are seeking legitimate help for acute or chronic pain conditions. But clearly, a lot of folks are becoming addicted, and thousands of them are dying each year from overdose. Despite increasingly irrefutable evidence that the real drug problem in this country is prescription medication, the vast majority of our drug policies in this country are still aimed at punishing those involved with illicit drugs. I’ll leave you with questions: When does a medication become a drug, and what is the difference between the two anyway?


  1. Check out the recent stuff Jerry Brown had to say about regulation and physician responsibility regarding opiate regulation. Of course he is stumping for governator so it was super focused on the "children" - nonetheless, he made some great points about the permissiveness and acceptance of legal violations when it comes to this class (my WC) of drug violations.

    Nice entry.

  2. It's really intense how prescription drug abuse is completely obscured in most discourses about drugs. I suspect it is largely because it isn't easy to target the middle-class, middle-age, white users as a dangerous problem population.

    I'm curious, in addition to the number of opioid overdoses, do you have figures on benzodiasapams (however you spell them, you know what I mean...)?

  3. Hi Zombie Mom and Diana! Thanks for the comments. Turns out it's hard to find much about the prevalence of benzo abuse, Diana, even though they are widely prescribed. The only thing I could find from SAMHSA is this:

    "Benzodiazepines are a class of central nervous system depressant drugs commonly prescribed for short-term treatment of anxiety or insomnia. Proprietary names for drugs in this group include Valium, Xanax, Librium, and Halcion.1 In 2000, benzodiazepines as a primary substance of abuse accounted for about 4,400 substance abuse treatment admissions. The "primary" substance of abuse is the main substance abused at the time of admission, while the "secondary" substance is another substance of abuse also reported at the time of admission. "Primary" benzodiazepine admissions constituted about 0.3 percent of the 1.6 million admissions in the Treatment Episode Data Set (TEDS). ...

    TEDS is an annual compilation of data on the demographic characteristics and substance abuse problems of those admitted for substance abuse treatment. "