Drugs, Death and Responsibility

I have been thinking a lot about drugs (illegal) the past few days..... not that I am planning on taking anything any time soon but rather I have been thinking about how the conversation about them has changed. With the rise in awareness of how addictive opioids are ( or at least an increased media awareness of how newsworthy it is) plus the ever increasing number of people who are over-dosing on fentanyl, it feels as if the responsibility  (or blame) for the addiction has perhaps shifted.

Canadian psychologist Bruce K. Alexander and his colleagues at Simon Fraser University in the late 1970s developed a convincing argument  (that was ignored by almost everyone) that heroin use had far more to do with social conditions then the addictive attributes of the drug. In the last decade or two Dr Gabor Maté of Vancouver had argued that a child's early environment, specifically how abusive it was, has a direct impact on why an individual becomes addicted. Neither of these two positions, backed by scientific data have ever received much public or political support. We have continued to outlaw and blame the users while ignoring the social causes for the addictions.

However within the past few months - if one only reads main stream media, the fault for the increase in opioid use and the alarming number of people who have died from a fentanyl over-dose is the fault of the doctors  for over prescribing a drug and the lack of treatment programs to help people with the addiction. I am sure that some doctors (perhaps most) have on occasion been careless about monitoring how their patients are using the pain medications. It is conceivable that there are numerous doctors who are either unaware that opioids can be highly addictive or who just don't care. But it is not conceivable that the majority of doctors are so incompetent. Similarly for patients talking such medications, they and their families would need to have their heads in the sands for extended periods of time to not be aware of the dangers of pain medications. Clearly doctors and pharmacists have some responsibilities for monitoring their patients medication, but the patients also have some responsibility to be aware of the dangers. However, I suspect that the vast majority of opioid users are people who have come to their addictions through some other process than their doctor over prescribing a specific medication. We ignore (as we have for the past forty or so years) the social causes of addiction at our society's peril.

The one main difference between opioids such as oxycontin and fentanyl as compared to more traditional street drugs such as heroin is that it appears to be far more addictive, far faster. Opioids are cheaper to manufacture, easier to smuggle, and dosages are far more inconsistent and therefore potentially more potent and dangerous.  This has resulted in the drug being more easily available to the "recreational" drug user who uses drugs less frequently and therefore his or her system is less able to cope with inconsistent or hidden dosages. Again, it is difficult to believe that these individuals are not aware at some level of the increased dangers of taking manufactured chemicals into their bodies. However, young adults have a strong sense of invincibility, of believing that something bad could not ever happen to them.  We might need to look at other methods of having  a dialogue with young people. Clearly the threat of punishment or death is not effective.

Traditional treatment programs dealing with addictions are in part based on changing lifestyles that have been warped by decades of addiction supportive behaviours. Those strategies may not be effective in dealing with addictions that happen so quickly and so powerfully. But I am not too sure if blaming the government for the lack of treatment programs is particularly useful. We ( the public and the government) could agree to fund more programs, but that would only be useful if we knew what would work. Clearly there needs to be an immediate investment into determining what would work. I suspect that such an investigation would suggest that, as in most treatment programs, it is not the short term intervention but rather the long term investment in supportive services that would provide the "cure". I am unconvinced that the public has any interest in providing long term support for anyone. We just want the quick fix so that we are free to go to resolve the next crisis.

Or we could look at the work of doctors Maté and Alexander and see if there is some correlation between their work and the apparent increase of middle class people becoming addictive to a new type of drugs. But that too might require a long term solution..........