Monday, January 22, 2018

How To Survive an (Opioid) Epidemic

To hear the news tell it, opiates in all forms are dangerous & have no place in medicine or society.  A single use can get you hooked or kill you.  The government has restricted physicians' ability to prescribe pain meds long-term--for that, patients will have to attend a pain clinic (which are also being forced to cut back on opioid prescriptions dramatically).  Tramadol & hydrocodone were re-scheduled in the last few years.  Everywhere you look, opioids are being demonized as more middle and upper class white people die of overdoses.

But what's the REAL story behind these deaths?  Opioids have been on both the legal & illegal market for centuries and there's never been this level of death & destruction.  Pure heroin, manufactured by Bayer, was once prescribed as a remedy for morphine addiction.  Jazz musicians & grunge rockers have all indulged across various decades and walks of life.  Opioids are nothing new, but this level of death certainly is.  More people are dying of overdoses than from car wrecks & gun violence combined.  But why?  You probably won't hear these reasons on the news.

Heroin bad; Carfentanil worse

Reason #1:  Pharma Flood

While Big Pharma flooded the market with legal Rx opioids like OxyContin & Zohydro for the last 20 years telling us they weren't addictive, people became addicted en masse.  Pill mills popped up in every city & drowned entire populations in these euphoric drugs.  And then they were suddenly cut off.  It doesn't take a genius to know what happens when addicts are cut off from their supply abruptly.  They turn to street drugs. 

REASON #2:  Black Market Adulterants

Heroin is cheap & abundant on the street, but fentanyl and its synthetic relatives are even cheaper.  They require no poppies to be grown & refinement of opium into morphine.  No smuggling of tons of heroin across borders inside drug mules.  A small bag can supply an entire region due to the sheer potency.  The risk of transporting fentanyl--as well as the financial reward--is infinitely better for drug cartels & dealers.  It's not the junkies who are demanding these synthetics.  It's the criminals controlling the drug trade.  This is an important distinction. 

So fentanyl & its many relatives (carfentanil, butyr-fentanyl, acetylfentanyl, 0-desmethyltramadol, W-15, U-47700, etc) are the #1 cause of opioid overdoses.  They killed Prince and countless others.  And these substances are only found in heroin & pills because of drug prohibition.  Ever wonder why you don't find methanol & other moonshine impurities in your beer & liquor anymore?  Because alcohol is regulated for quality & purity.  Because alcohol is LEGAL.  It's still dangerous & unhealthy, but it's legal.  If heroin & pills were legal, they could be regulated for purity & sold to adults 21+ the way alcohol & cigarettes are.  Hell, if drugs were simply decriminalized it would allow for drug testing centers to exist so addicts could test their drugs for adulterants like fentanyl without fear of incarceration.  Because if there's one thing that DOESN'T work, it's forced drug treatment or prison. 

REASON #3:  Deadly Combos

The second leading cause of death among opioid users is combining opioids with benzodiazepines, alcohol & other downers--a mistake that could largely be prevented with proper drug education & harm reduction information.  Rock singer Tom Petty made this fatal mistake & it cost him his life.  Benzos are nearly impossible to overdose on by themselves, but when combined with opioids they become deadly, slowing respiration & heart rate to dangerous levels. Yet we aren't hearing news of a "benzodiazepine epidemic".  These drugs remain in Schedule IV, which is one step away from over-the-counter.

Drug purity test kit

So what's the solution?  As always, Americans are now demonizing an entire class of drugs and their users as doctors cut pain patients off their much-needed medications.  And with Sessions & Trump in office there will likely be a coming wave of incarceration for poor & minority drug users if we don't do something NOW.  The harsh reality is, as long as the drug war's Zero Tolerance policy stands, people will continue dying from adulterants like fentanyl & receiving faulty drug education like the "Just Say No" abstinence-only methods taught by D.A.R.E. that have been proven to not work.  This needn't be the case.  We can change course at any time.

We must employ harm reduction services immediately for those addicts who wish to continue using and affordable rehabilitation services for those who wish to stop.  If we let one more person die of a fentanyl overdose, we've failed.  Our government has failed.  Our public health services have failed.  We pay taxes so we can have these services & they're not being used to help the most vulnerable among us.  Until we stop treating addiction as a crime & start treating it as a disorder, we will keep losing bright, talented human beings to senseless and avoidable causes.

We need Naloxone available over-the-counter with no questions asked in all pharmacies.  Needle exchange centers in every city; drug purity testing sites in all major cities.  Hotlines for users to call anonymously & ask questions pertaining to drugs, such as dose & interaction information.  Safe injection rooms for IV drug users.  And there's so much more that could be done if we simply loosened our drug laws.  Contrary to popular belief, it's possible to use opiates & hold down a job, maintain a family & go to school, but not when all your time is spent stealing, panhandling, prostituting or trying to figure out ways to finance your habit & obtain your next hit.  Addicts CAN be productive members of society if given the chance.  They're called "functioning addicts" and they're everywhere.  You probably have one in your family or peer group.

While we can't save everyone, a majority of these deaths can be prevented with common sense policies.  We have to wake up & start handling our drug problem the way Portugal, the Netherlands & other countries with reasonable drug laws do.  Our leaders have the data; they know what works & what doesn't.  If it doesn't piss you off that they're CHOOSING to continue killing people with the same old ineffective methods after 80+ years of drug prohibition, you're not paying attention. 

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