Looking ahead, reducing drug overdoses will require major shifts in how we approach substance use.
First, and possibly most importantly, Maryland needs to connect individuals struggling with addiction to high-quality addiction treatment that is integrated with their primary care. Primary care providers should be monitoring the long-term health and progress of those struggling with addiction, ensuring that the substance use treatment they are receiving dovetails with an overall health strategy.
Next, we need better monitoring of how often pain medication is prescribed. Research indicates there is an increase in the prescription of opioids that is not driven by clinical necessity. Many public health officials have identified the rise in prescriptions of opioids as a significant factor driving pharmaceutical overdose deaths, which quadrupled between 1999 and 2010, and as a gateway to other substances such as heroin.
Additionally, we need to educate patients that prescription drugs are, in fact, highly addictive and should be used with caution. A strategic and hard-hitting public awareness campaign would help people better understand the slippery slope from prescription drugs to street drugs.
And finally, we must undo the stigma that paralyzes individuals struggling with addiction that deters them from seeking help. This will require a shift in public policy — beginning at the highest levels — from criminalization to a focus on the medical and public health implications of addiction.
Holy grails are few and far between. Pharmaceutical holy grails are no different. They are as rare as a moderate position in the Scottish independence debate. We have a few prescription drugs licensed to treat addiction and some make things significantly better, some have modest impacts, and some appear to have little impact. Regardless of impact, what a great deal of faith we place in molecules to manage complex bio-psycho-social problems like addiction – or depression for that matter. It looks as if our faith often exceeds the pharmacology.
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If we encourage our clients to trust in medication to do the work at the expense of doing the tough job of behavioural change, then we let our clients down. Too high a faith in pharmacology is disempowering. It’s not that medication doesn’t make an impact; it clearly does. My worry is that we place too much belief in medication and this may cause us to miss out on the otherwise rather obvious fact that recovery from addiction does not take place primarily because the prescription is right. While many recovering people can identify the part that prescribing played and are grateful for it, we don’t often see clients coming back to their prescribers saying “I want to thank you because your prescription was just right and because it was great it met my pharmacological deficits and I got into recovery.”
No, what they will say is “Thank you, you were great. You helped get me on my way, you connected me up to the right people and assisted me to sort out my problems. You had time for me and you listened to me. You supported me and believed in me.” That’s more efficacious than any drug.