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Addiction and the Opioid Epidemic

Youth Heartline's Facebook post about the root of addiction has reached a whole ton of folks -- 831 at the time of writing! We focus on addiction because the number of children who enter foster care due to neglect caused by parental substance abuse is sky-rocketing in this country. And any trend in foster care is always the tip of the iceberg of the true number of children suffering.

If you missed our post, here's a link. Essentially, journalist Johann Hari (who wrote the book Chasing the Scream about the War on Drugs and its failures) talks about scientists in the 1970s revisiting famous rat experiments that offered the most condemning evidence for the harmfulness of drugs.

Lookit that cutie!

In redoing those experiments, the environment the rats were in was changed from a solitary cage with nothing to do but drug yourself (original) and to a wondrous "rat park" filled with toys and other rats to play with (revamp). The difference in results was startling. Drug use in the rat park was not zero, but there were no ODs, in contrast to the solitary cages where the rats essentially drugged themselves to death.

The rats with good lives didn’t like the drugged water. They mostly shunned it, consuming less than a quarter of the drugs the isolated rats used. None of them died. While all the rats who were alone and unhappy became heavy users, none of the rats who had a happy environment did. - Johann Hari

So, Hari submits, there is support for the idea that there isn't something intrinsically bad about drugs but that loneliness and isolation are at the root of addiction and that authentic connection, not punishment (usually in isolation) is the appropriate solution. Hari points to Portugal, which has decriminalized drugs and seen amazing decreases in addiction in its population. He also argues that since morphine is fundamentally the same as heroin, there must be something else going on other than the drug itself to create addiction, otherwise we would see many more folks become addicted through health care.

It's persuasive. Except for that last point.

We do see a lot of folks addicted to opioids through health care. Lots of them. And not just direct patients, but their family members too. German Lopez from Vox News wrote an article published today covering some of the thorny issues around drug legalization and the opioid painkiller epidemic which now kills more in the U.S. than illegal drugs.

I saw friends of family members die to drug overdoses. I spoke to drug users who couldn’t shake off years of addiction, which often began with legal prescription medications. I talked to doctors, prosecutors, and experts about how the crisis really began when big pharmaceutical companies pushed for doctors and the government to embrace their drugs. - German Lopez

Vox News also published a graph that demonstrates that the prescription length for opioid painkillers matters a great deal with respect to the likelihood that the patient is still using a year later. The big inflection point is between a 5-day prescription and a 6-day prescription when the likelihood of continued use a year later doubles. (Note that the chance of becoming a user a year later is still low in both cases -- it just happens to be twice as likely with a 6-day prescription vs. a 5-day one).

However, none of this is to say that Hari is wrong and that we shouldn't change our approach to substance abuse and addiction. If nothing else, the real-world example of Portugal is very inspiring. And I happen to believe that Hari (and now many scientists) are on to something when they say that addiction is connected to loneliness. We recently posted to Facebook that 27-28% of Americans are affected by loneliness. (See that post here if you missed it!) If that's true, then it's no wonder that we've got an opioid epidemic on our hands and addressing loneliness must be part of our changed approach.

The bottom line is that the issues of drugs, addiction, and how we should address them are complicated, and that it's unreasonable to think there's an easy solution. The opioid epidemic is tough to parse. There are certainly room to think that some medical practitioners are making them too available. We have heard that significant amounts of opioids are given to patients who are suffering from conditions that do not seem to merit them. However, they are also legitimate medical treatment for pain that often do not respond to anything else.

If you haven't seen it yet, the documentary Dr. Feelgood, I highly recommend it. I believe it's currently available on Netflix. And it sympathetically captures both sides of this issue when it comes to opioids.

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