As a result of a national political and media push, most citizens are aware of the ongoing opioid (painkillers, fentanyl, heroin) addiction epidemic. While it is usually presented in terms of frightening statistics (Google “opioid crisis” and you will get an eyeful), I would like instead to discuss some deeper issues.
All mammals get addicted to the exact same drugs including alcohol. All mammals have the exact same drug withdrawal symptoms. All mammals experience the same course of compulsive drug use and the same override of the natural instinct to survive. We know exactly where in the human brain addiction develops as that part of the brain lights up in a very particular way with neuroimaging. That part of the brain is nearly identical in all mammals explaining the findings above. We have learned a lot about addiction from studying animals just as we have learned a lot about diabetes from studying animals. As with diabetes we have not yet found a cure.
Drug addiction and Type 2 diabetes are both genetic. The more strongly it runs in your family, the more likely you are to get it. Drug addiction and Type 2 diabetes are also lifestyle illnesses. Excessive caloric intake, poor diet and sedentary lifestyle “trigger” the onset of Type 2 diabetes. Excessive risk taking and consumption of drugs “trigger” the onset of drug addiction. Once “triggered,” these diseases are essentially permanent. One can live fruitfully with these diseases by dealing with them, but the consequences are often disastrous if the disease is neglected.
We are currently experiencing an epidemic of Type 2 diabetes due to the exposure of our population to improper nutrition (“junk food” designed to be addictive by the large food “manufacturers”). We are experiencing an epidemic of opioid addiction due to the exposure of our population to prescribed painkillers. Physicians and politicians were manipulated by pharmaceutical companies into believing that more widespread use of opiate painkillers was safe and justified. The percentage of the population taking opiate analgesia tripled from 1996 to 2012 when it reached a high of 12 percent. Heroin use grew dramatically, with four out of five heroin users starting with abuse of a prescription opioid. Pharmaceutical companies are now under the pressure of lawsuits filed by many states (Oregon’s Department of Justice is considering a second lawsuit), but this will never make up for the deaths of greater than 100,000 individuals from this epidemic.
Type 2 diabetes can often be effectively treated with rigorous behavior modification including weight loss and a healthy diet (a ketogenic diet was the leading treatment of diabetes before medication). Drug addiction can obviously be treated with abstinence. The problem is that most patients do not make the necessary lifestyle changes to prevent the end stage symptoms of their disease. Many patients with Type 2 diabetes keep eating junk food and many patients with Opioid Use Disorder keep using the opioid.
While most physicians would rather see their Type 2 diabetics change their diet and not need medication, they do not withhold medications waiting for the patients to change their behavior, because this would increase the risk of the patients developing permanent eye or kidney damage.
Similarly, there are medications such as Suboxone (which is itself addictive and hard to quit) that treat some of the most damaging effects of Opioid Use Disorder. Physicians do not withhold such medications while waiting for the patients to change their behavior, because this would increase the risk of death or severe organ damage. Starting in 1995, France cut their opioid overdose death rate by 79 percent after making buprenorphine (the active ingredient in Suboxone) widely available. To my knowledge there is not a single study that failed to demonstrate dramatic decrease in overdose rates and improved outcome with buprenorphine treatment.
Naloxone (Narcan) is a medication that reverses overdose once it occurs. It can literally save a life within seconds. There is a nasal spray form that is easy to use and should be available to everyone who runs any chance of coming across an individual who has overdosed with opiates. All patients with Opioid Use Disorder and their families should have this available. It is paid for by OHP and can be obtained from the pharmacy without a prescription.
Editor’s note: The Union County Republicans did not submit an On the Fence piece about the opioid crisis.