Mahaffey: Opioid Addiction: Understanding the True Enemy
It saddens me that opioid addiction has culminated into a national emergency, but hopefully this will encourage a societal change in attitude. To gain control of this epidemic, it must be recognized that addiction is not a failure of willpower and that addicts are not sub-human because of a disease they battle.
Addicts are our family members, friends, neighbors and co-workers. Addicts are all around us day after day, and we accept them fully into our lives until their disease is discovered. The American Medical Association has defined addiction as a disease for more than 30 years, yet attitudes and the justice system have been slow to grasp this point.
Attitudes toward addiction and depression are comparable. It's almost impossible to grasp the overwhelming despair and darkness that controls the person. The difference, however, is that we treat depression with evidence-based medicine, but we attempt to control addiction through the criminal justice system, which has not and will never work.
The many contributing factors to this epidemic have been discussed at length. Doctor education and guidelines are necessary for both opiate prescribing practices and addiction, but let's not forget about the 2.5 million Americans who are already addicted. It is too late for those individuals to tackle the problem from the prescribing end. They need treatment without shaming. Many people are prevented from seeking treatment, not just those with few means. Help is elusive and seeking it often destroys relationships, careers, financial stability, reputation and self-worth.
Most people do not choose to be addicted. Millions of people are prescribed pain medication for legitimate medical purposes and many are able to stop when the medication is no longer needed. However, we know that about 10 percent of the population is susceptible to addiction and 4 out of 5 heroin users started with prescription pain pills.
An addicted brain is in a diseased state. It's hard to empathize with an addict's inability to simply not use the drug. However, research is clear on the changes that occur during addiction causing the brain to see the drug as necessary to sustain life and altering the brain's ability to rationally assess needs and consequences. Basically, the brain has been hijacked and tells the person the drug is priority number one — over all other survival instincts.
Studies on addicted and starving rats have demonstrated they choose more drug over food and water. We expect addicts to think the way we do, but we neither know nor understand what it is like to think with a damaged brain. We don't ask someone who is psychotic to simply stop hallucinating. Once that point is reached, structured treatment support is the only answer, and it is unrealistic to ask someone to simply "snap out of it" and make better choices.
It occurs far too frequently that help is not immediately available when someone is ready. It is unrealistic to send an addict home with a number to call for an appointment or to be placed on a wait list and expect them to stay drug-free while suffering through increasingly severe withdrawal symptoms.
With hundreds of thousands of people expected to die of overdoses over the next 10 years, let's put aside the stigma and our moralistic objections to proven evidence-based interventions. Medication-assisted treatments like methadone and buprenorphine, are "essential medications" for opioid addiction, according to the World Health Organization. They reduce mortality by more than half. They restore balance in the circuits of the brain disrupted by addiction, thus stopping the cycle, and allowing the person to feel normal again.
Family, friends, neighbors and coworkers who are struggling need your support. Help them maintain a sense of dignity and remind them they are not alone. If you suspect someone is addicted, do not enable, but take the time to let them know you care and will assist finding help. Setting boundaries encourages him or her to seek help.
As long as there is life there is hope. More families touched by this disease should allow us to grow as a society and accept that addiction is the enemy — not the afflicted.