Saturday, May 29, 2010

Doctors and drugs

Clinton McCracken, a Canadian drug researcher, recently did a brave and unusual thing --  he published an article in JAMA [readers may have to view an ad] describing his own drug use.  His narrative troubles the DSM IV criteria for substance abuse and disrupts the silence of researchers and medical professionals surrounding their relationship to addiction.  He was able to use drugs consistently for years without meeting the criteria for abuse.  Indeed, in the end, the harm that came to him was less from his drug use than from the criminal justice response to it.  However, the story of his fiancee, who died following a bad reaction to injection drugs, unfortunately reminds us of the very real harm that drugs can do, especially drugs bought on the street or through overseas online pharmacies.   Given our current system of criminalizing some drugs, many people, like McCracken's partner, put themselves at risk trying obtain drugs and/or end up with drugs that contain hazardous adulterants or contaminants.  This may be one reason why many people are increasingly reliant upon prescription medications obtained from their own doctors.

What is striking about McCracken's account is how rarely we hear from researchers or medical professionals either about their own drug use or about their own role in supporting addiction.  I am not trying to demonize doctors.  In fact, some accounts suggest that doctors are prescribing opioids either to keep their patients away from heroin and the dangers associated with obtaining and using it on the street and/or to help them establish a steady source of income.  It seems to me that doctors need safer and better ways to talk about addiction -- how they deliberately or unwittingly support it, how they clandestinely treat it, how they want to treat it, and how addiction affect their own lives.   Unfortunately, doctors are silenced by the stigma and very real professional and legal consequences of talking openly about these issues.  I don't necessarily agree with everything McCracken had to say, bur I do applaud his willingness to raise these issues publicly among his peers.

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