It is now understood that some of us, some of you, some of every group have a genetic predisposition to opioid addiction, also known as opioid Substance Use Disorder (SUD). Even exposure to only a few days of certain prescription opioid pain medications can lead to a lifelong addiction to opioids for those of us with this genetic makeup.
You didn’t choose the genetic code written into your chromosomes at the very moment of your conception. Yet it is this karmic destiny which often determines who develops opioid SUD and who does not.
The vast majority of our neighbors with SUD were not led to this condition because they were hopelessly ill, “somehow deranged,” or otherwise “different” from us. These folks are our neighbors, family members, coworkers and friends. They are us.
Over three quarters of heroin addicts had their first exposure to an addictive opioid in the form of a prescription opioid pill. Who has not suffered a traumatic injury, had a tooth extracted, passed a kidney stone, given birth to a child or received a life enhancing joint replacement? For some of us, such routine events, in conjunction with opioid prescriptions, can result in lifelong addiction as surely as night follows day. There but for the grace of God go any of us.
Our graveyards are full of formerly productive students, employees and retirees, who through their own medical prescriptions, developed opioid tolerance, dependence, addiction, overdose and death.
Others in their premature graves first experienced opioids through the bad decision to accept an all-too-available prescription opioid pill from a friend or relative. (Who among us has not made a bad decision?) In the United States, we prescribe 300% to 400% too many opioid pills, which can addict their intended recipients and when diverted, can create new opioid addictions within the public, fueling this horrific epidemic. (Ending opioid over-prescribing will be the subject of a future post.)
Once addicted, patients with SUD become trapped within the vicious cycle of opioid addiction. In time, most patients with SUD are not looking to get high, but rather to stave off the awful symptoms of withdraw, day after terrible day. (What a horrible product; it actually makes its customers physically ill if they don’t keep purchasing the stuff!)
Substance Use Disorder (SUD) is not some kind of moral weakness or a personal failing. It is a chronic physical disease of the brain amenable to successful Medication Assisted Therapy (MAT), just like other chronic physical diseases such as diabetes or hypertension are treatable with medication. We need to make MAT more readily available, as MAT is currently markedly underutilized.
Why should you care? To paraphrase the bipartisan presidential task force upon which former Democratic Congressman Patrick Kennedy and current Republican Governor Charlie Baker just recently served:
Because every American should awaken to this simple fact: If this scourge has not yet found you or your family, without bold action by everyone, it soon will.
Stop the Stigma and please support patient access to Medication Assisted Therapy.
2 Comments
So I happened to checkout your blog the day Trump declared it a national emergency. Does this declaration mean something or do something if it doesn’t involve the commitment of additional resources?
Hi Steve,
Thanks for your thoughtful question.
Trump’s declaration of a public health emergency is not a declaration of national emergency under the National Emergencies Act or Stafford Ac. Hence the President cannot spend money on his own directly from FEMA. Congress will need to act to appropriate necessary funds.
The President’s Commission on Combating Drug Addiction and the Opioid Crisis recommended the president choose between a public health emergency (which he ultimately chose) and a national emergency. Governor Chris Christie, Chairman of the President’s Commission on Combating Drug Addiction and the Opioid Crisis recommended a public health emergency declaration, rather than a national emergency declaration.
According to CNN, there are currently 28 active national emergencies, (Who knew?) and it is apparent that none of them are related to healthcare, and all of them appear related to foreign policy / conflict. The active declarations date back to the Iran Hostage Crisis in 1979, and are listed below courtesy of CNN: (http://www.cnn.com/2017/08/12/politics/national-emergencies-trump-opioid/index.html)
1. Blocking Iranian Government Property (Nov. 14, 1979)
2. Proliferation of Weapons of Mass Destruction (Nov. 14, 1994)
3. Prohibiting Transactions with Terrorists Who Threaten to Disrupt the Middle East Peace Process (Jan. 23, 1995)
4. Prohibiting Certain Transactions with Respect to the Development of Iranian Petroleum Resources (Mar. 15, 1995)
5. Blocking Assets and Prohibiting Transactions with Significant Narcotics Traffickers (Oct. 21, 1995)
6. Regulations of the Anchorage and Movement of Vessels with Respect to Cuba (Mar. 1, 1996)
7. Blocking Sudanese Government Property and Prohibiting Transactions with Sudan (Nov. 3, 1997)
8. Blocking Property of Persons Who Threaten International Stabilization Efforts in the Western Balkans (Jun. 26, 2001)
9. Continuation of Export Control Regulations (Aug. 17, 2001)
10. Declaration of National Emergency by Reason of Certain Terrorist Attacks (Sept. 14, 2001)
11. Blocking Property and Prohibiting Transactions with Persons who Commit, Threaten to Commit, or Support Terrorism (Sept. 23, 2001)
12. Blocking Property of Persons Undermining Democratic Processes or Institutions in Zimbabwe (Mar. 6, 2003)
13. Protecting the Development Fund for Iraq and Certain Other Property in Which Iraq has an Interest (May 22, 2003)
14. Blocking Property of Certain Persons and Prohibiting the Export of Certain Goods to Syria (May 11, 2004)
15. Blocking Property of Certain Persons Undermining Democratic Processes or Institutions in Belarus (Jun. 16, 2006)
16. Blocking Property of Certain Persons Contributing to the Conflict in the Democratic Republic of the Congo (Oct. 27, 2006)
17. Blocking Property of Persons Undermining the Sovereignty of Lebanon or Its Democratic Processes and Institutions (Aug. 1, 2007)
18. Continuing Certain Restrictions with Respect to North Korea and North Korean Nationals (Jun. 26, 2008)
19. Blocking Property of Certain Persons Contributing to the Conflict in Somalia (Apr. 12, 2010)
20. Blocking Property and Prohibiting Certain Transactions Related to Libya (Feb. 25, 2011)
21. Blocking Property of Transnational Criminal Organizations (Jul. 25, 2011)
22. Blocking Property of Persons Threatening the Peace, Security, or Stability of Yemen (May 16, 2012)
23. Blocking Property of Certain Persons Contributing to the Situation in Ukraine (Mar. 6, 2014)
24. Blocking Property of Certain Persons With Respect to South Sudan (Apr. 3, 2014)
25. Blocking Property of Certain Persons Contributing to the Conflict in the Central African Republic (May 12, 2014)
26. Blocking Property and Suspending Entry of Certain Persons Contributing to the Situation in Venezuela (Mar. 9, 2015)
27. Blocking the Property of Certain Persons Engaging in Significant Malicious Cyber-Enabled Activities (Apr. 1, 2015)
28. Blocking Property of Certain Persons Contributing to the Situation in Burundi (Nov. 23, 2015)
The President’s Commission on Combating Drug Addiction and the Opioid Crisis made 56 separate recommendations, which if enacted, would make a world of difference. We will see how many are enacted. Regarding funding, the taskforce noted:
“The Commission urges Congress and the Administration to block grant federal funding for opioid-related and SUD-related activities to the states, where the battle is happening every day. There are multiple federal agencies and multiple grants within those agencies that cause states a significant administrative burden from an application and reporting perspective. Creating uniform block grants would allow more resources to be spent on administering life-saving programs. This was a request to the Commission by nearly every Governor, regardless of party, across the country.”
Let’s see if the politicians can get out of their own way and help patients who desperately need that help now.
The full report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis is available here:
https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-1-2017.pdf