Kicking the habit

The three recent incidents in the area (Jacksonville?!?) are unfortunately not a statistical anomaly, but part of a larger trend engulfing the country. In just one day, seven overdose deaths were reported in the greater Cleveland area of Ohio. Since 2009, drug overdoses have been responsible for more deaths than car accidents and shootings nationwide. Heroin deaths have increased by 439 percent in the past 15 years up to 2014, and overdoses related to opiods – heroin’s chemical cousin – accounted for 28,647 deaths two years ago.

From 2014 to last year, the drug overdose death rate in Illinois increased six percent to just under 15 deaths per 100,000 people. To put this into perspective, the country’s overall murder rate (which has recently been reported by the FBI as rising overall) stands at 4.9 per 100,000 people and in 2015. Chicago, a city infamous for its gun violence, has a murder rate of 15.09 per 100,000, putting it about even with the overdose death rate, a stunning statistic. It is true that the nature of these deaths differ in intention and their effect on feelings of overall safety and wellbeing amongst communities. But the fact that as many people are dying from drug overdoses in the state as from violent gun crime in its most violent city means that it is a problem that can no longer be brushed aside.

The problem becomes even more apparent when one realizes that Illinois overdose death rate doesn’t even break into the country’s top ten. In fact, its rate is less than double of the West Virginia, which holds the ignominious distinction of being the state most afflicted by the epidemic with an overdose death rate of 37 per 100,000; McDowell County is its most concentrated source of deadly overdoses with an average of 131 per 100,000, placing it above even the world’s most dangerous city of Caracas, Venezuela, with a current murder rate of 119 per 100,000. Coming in a close second to the Mountaineer State is New Hampshire with a year over year increase of 24 percent and an official death rate of 32 per 100,000 people (the only state that saw a bigger increase was Massachusetts, whose deaths jumped 28 percent since 2014).

From this list, it is tempting to conclude that the issue is concentrated within the Appalachians and areas throughout the country that have been negatively affected by factory and plant closings. These observations have merit, but they also minimize the scope of the epidemic. It is not only unemployed blue-collar workers who have turned to the highly addictive substance to escape, but the overprescribed masses from all economic backgrounds who have had to adapt to a more stringent medical regulation landscape. Patients with genuine conditions have for too long been treated with physically-addicting medications that either are too powerful for the required analgesic qualities, or have been allowed to continue with treatment far longer than is considered optimal from an addiction standpoint.

As opioid abuse continued to metastasize into a problem far greater than what could simply be considered fringe abuse, government entities began to implement and enforce stricter protocols for the prescribing of painkillers. Doctors known for their proclivity to treat a number of ailments with painkillers more powerful than necessary were warned to cease such practices; offices known for an even more laissez-faire attitude of doling out drugs, known as “pill mills,” have become high priority targets for the DEA. The idea to reign in such easy access to addictive substances is sound. Unfortunately, a plan – no matter how noble – will have unintended consequences: those people who had benefitted from over prescription and limitless refills now had little to no access to drugs with high potential for abuse.

The difference between psychological addiction and physical addiction is that the former is highly correlated to personality while the latter is controlled by chemical reactions that have the ability to overwhelm rational willpower. The nonchalant attitude towards opioids in the past 15 years has snared both people with a penchant for abuse and those who would otherwise not seek out artificial highs. Patients with injuries and ailments not necessarily acute enough to pass the pain threshold for narcotics were given them anyway. Those looking for a high were met with little resistance for difficult to disprove maladies like back and joint pain. And for those saddled with truly debilitating – albeit temporary – pain, endless refills were on tap. This created an advantageous environment for those seeking relief from discomfort, whether physical or emotional.

Narcotics’ effectiveness is inversely related to its frequency of use; in other words, it takes increasingly higher dosages to enjoy the same effect as when it was first used. This leads to a self-reinforcing habit in which a person seeking the same relief must ingest increasingly higher doses. This then leads to a more intense physical dependence on the substance as these higher doses begin to overwhelm the body’s regular chemistry. As the implementation of stricter protocols filtered through the health industry the once bountiful supply of opioids became increasingly more difficult to acquire.

Those who had become dependent and desperate enough sought out other sources from which to satiate their desire. These include the aforementioned pill mills, as well as drug dealers and online black markets. The recent spate of clustered overdoses (one county in Ohio had 14 overdose calls in one shift) throughout the country has revealed what most already know: the black market is not exactly a paragon of safety standards. The recent incidents involving the previously less popular drugs fentanyl and carfentanil only solidify the dangerous situations in which people have resorted to placing themselves to satisfy a craving.

For the uninitiated, fentanyl is more than 100 times stronger than morphine and up to 50 times more powerful than heroin. Carfentanil, an elephant tranquilizer, is itself 100 more times powerful than fentanyl and thus can be up to 50,000 times (!) more potent than heroin. The overdose clusters have been blamed on both drugs. The reason being that buyers are unable to confirm the authenticity or determine the potency of illegally purchased substances. As if the dangerous uncertainty was not enough carfentanil is digested more slowly than its less powerful counterparts, resulting in much longer lasting overdose; it is so potent that first responders have been instructed to don protective masks and gloves because even touching or inhaling a minuscule amount of the substance can have severely negative effects. People simply do not know what they are putting into their bodies.

There is enough blame to pass around for the epidemic engulfing the nation. Passing the buck from one party to another will not solve the problem of addiction. Restricting access to drugs that were once basically unrestricted has caused a vacuum in which physically dependent people have tried to fill. Closing down pill mills and more clearly defining stringent protocols for prescribing painkillers is a move in the right direction. But this adjustment does not solve the problem for those who have become addicted enough to turn to the increasingly dangerous underground market.

Providing clean needle programs and drug quality test kits is a controversial topic. It can be argued that taxpayer money is being used to enable a person’s drug habit. This would be true if that was the only program available for addicts. However, these two services – which help minimize the spread of disease and death by overdose – can be coupled with local rehabilitation programs for those seeking assistance to eliminate drug dependence. People don’t wake up one day and decide to become an addict. Those who otherwise would have never imagined themselves in the position commit crimes to satisfy their addiction. First responders must first stabilize a patient before they or emergency room services can provide a treatment. The same should be done for people addicted to a substance.

Part of the problem with medical care today is that patients are treated to alleviate the symptoms of a malady rather than homing in on the root cause. The remedies are never easy or perfect, but when one medicine is ineffective, the proper course of action is to either use it in combination with another treatment or try to find a new course of action altogether. The symptoms will continue to morph and metastasize but the root cause of addiction remains the same. In order to cure the disease, the current treatment needs either a complement or a complete overhaul. Sticking with a strategy when it produces poor results is an addiction itself. It is a habit that should be kicked.

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