When a war is waged there are always casualties. The national “war on drugs” is the most recent tragic example and there appears no end in sight. As it classically trained American medical school graduate (Ohio State University class of 1981) with over 35 years in medical practice, I can only shake my head and wonder how we ever reached this point where we’re losing over 100 human lives daily across the United States. We’ve become Overdose America.
Imagine if we were losing 100 soldiers every day
To put these numbers into perspective, imagine if we were losing 100 soldiers every day in an overseas war or if we suffered a 9/11 type terrorist attack in any American city which resulted in over 100 deaths daily. We would have protests in the streets and massive action to stop the madness. How can we cast such an unconcerned eye as our fellow Americans suffer the side effects and consequences of narcotics, both short term and long term? Young and old, rich or poor, large swaths to the public are being affected.
Addiction is Non-Discriminatory
One’s race is meaningless. Their professional status and education are irrelevant. All can (and have been) taken down by narcotic addiction and abuse. We have all been witness to the dangers of opiates, and it’s time to take a very difficult and introspective view of the addiction crisis. It’s surely not going away.
Do we have the will as a society to battle back? Do we have the freedom to do so? Can one doctor really make a difference? Can a plant that’s been around for as long as we have been recording history help to fight back? My answer to all of those questions is a very definitive yes!
Emergency Medicine and Addiction
The world of emergency medicine offers an interesting perspective into the multi-faceted drug addiction and overdose epidemic. The medication Narcan is an old friend. This narcotic antagonist lifesaver has been around forever and is a standard discussion in the first day of orientation for every ER provider – from EMT students to a grizzled veteran ER physician. If you can administer the Narcan to the patient in a timely fashion with respiratory support prior to the administration, no one should die. This is why Narcan is now being touted as a savior in the crisis, especially since it’s easily dosed by nasal spray. Personally, I feel this is a horrible way to truly address the problem of opiate overdose.
As someone who was resuscitated more narcotic overdose patients that I can ever think to remember, I can say with confidence that the solution to this social cancer is not Narcan. This epidemic is much greater than the ultimate Naloxone “save” at the end of the course of narcotic use and abuse.
It’s not always abuse that kills at it’s clearly not a recreational pursuit for many, but acute intoxication and death is caused by a fruitless course towards attempting relief of symptoms such as pain, anxiety/depression, and sleep issues.
Accidental overdose is sadly frequent with prescribed pills being the leading cause of death for Americans under the age of 50. Many celebrities such as Prince, Michael Jackson, and others have succumbed to the negative effects of opiates. Tiger Woods was nearly a victim, though he’s been spared death only to suffer humiliation and require treatment for his “pill use,” which caused him to be found in his car and foot on the brake, unable to drive any further.
More than Opiates
This epidemic of addiction extends further than opiates. Of vital importance, the most common gateway drug is alcohol – be it from a parents unlocked bar or from a crooked convenience store owner. If an individual begins abusing alcohol in high school (or earlier), this abuse portends continued abuse issues of all types.
Alcohol has fueled countless stories of acute and chronic behavior resulting in severe injury and death. Countless lives have been ruined by acute domestic violence caused, in part, by daily alcoholic ingestion. I have never seen a wife assaulted by her husband after he had “smoked a joint.” While I advise every patient to never medicate while or before driving a vehicle, many of the most severe high speed auto accidents are alcohol related. In my entire practice as a medical doctor, I have never cared for anyone severely injured from a cannabis related auto accident or other injury caused by any THC effect.
One of my favorite anecdotes learned from living in the emergency room culture for three decades has always been that it’s the drunk kid who will be in the ER vomiting with the IV running, taking up nursing and doctor time, while there “stoned friends” are in the waiting room raiding the candy machine.
Cannabis: Gateway or Exit Drug?
In adults, the gateway drug to opiate abuse are opiates themselves. Acute injury sometimes leads to unintended, inexorable tragic path towards chronic use and possible addiction. “Big Pharma” companies have been ruthless in their pursuit of dollars to the detriment of the American public. This epidemic caused by the pharmaceutical industry’s marketing efforts have led states like Ohio to formally file suit against these immoral companies who have successfully peddled their poison to the populous.
Rather than the classic label of “gateway drug,” I believe cannabis is actually an “exit drug” that can be used successfully in opiate and narcotic recovery period. The federal propaganda machine had its way for far too long and continues to protect Big Pharma interests to the detriment of patient care.
Rather than the classic label of “gateway drug,” I believe cannabis is actually an “exit drug” that can be used successfully in opiate and narcotic recovery period.
In the Past...
Dating back to the invention of the hypodermic needle long ago, the drug companies of the time (such as Bayer) quickly learned that oil-based cannabis preparations could not be processed to use to be injected intravenously and thus would not ever be of similar financial benefit as other water-soluble opioids. Doctors at the time fought hard to continue to keep safer cannabis-based products available, but ultimately lost out to the more organized and well financed drug lobby and federal government prohibitionist movement in the early 1940s.
Many people don’t realize that doctors boycotted their hospitals after cannabis was removed from the American pharmacopeia in 1941. These physicians fought for their patients by staging an organized strike for a few days, demanding they be able to prescribe and treat patients with this medicinal herb. Eventually the prohibitionist tide swept the country and these defeated clinicians had to accept the fate of this social decision. I often wonder if, perhaps, the times in which we live now may have been altered had my brave colleagues of the past had prevailed in their fight.
What do We Do Now?
If you look at the issue of alcohol and drug abuse from both the social and scientific aspects, I believe that the physically addictive nature of both alcohol and opioids show it distinct difference from cannabis.
Every ER doctor quickly learns to recognize the physical signs of alcohol and narcotic withdrawal, as he or she must be able to quickly diagnose and treat the potential deadly seizure disorder associated with alcohol detoxification. It’s easy to see the agitation with these patients like sweating, nausea/vomiting, and shaking. Alcohol withdrawal has the potential to kill you and narcotic withdrawal makes you feel like you want to die.
Substances like opiates, alcohol, amphetamines, and cocaine are physically addictive. Not only are you hooked mentally, but when you try to stop your body says – very firmly – “NO!” it takes strength and primal determination to stop using a substance when your body has developed a dependency.
Inexpensive, national legal, and sold on Sundays, alcohol is widely available to Americans. Every day it fuels daily mayhem about the country with countless auto accidents, domestic violence, and other unintentional accidents being caused by its widespread use and abuse. Chronic alcohol abuse is easy for a position to spot, often just by seeing the reddened, ruddy nose. It is within the body, hidden from view, where alcohol causes its greatest damage.
I’ve watched someone nearly bleed to death from vomiting blood from esophageal veins engorged by the backup of blood from their damaged liver. I’ve witnessed pickled alcoholics walk into my ER with the blood alcohol content of .400+ knowing their inner body and organs are destroyed. It’s just a matter of time before death results, and alcoholism affects not just the patient, but loved ones, coworkers, and neighbors.
Opiates offer the same challenges in withdrawal, both with appropriate legal use and illegal drug abuse. Powerfully addictive and more readily available than ever, they offer many of the same issues as alcohol but at the disaster of the ease of acute overdose and death.
While opiates are widely available, they’re not as inexpensive as alcohol. When a patient runs out, the addictive physical drive leads them to either to see their doctor or go to the streets – where uppers, downers, pills, heroin, and carfentanyl are available in steady supply. Should a person not have the financial means, societal mayhem will ensue. Addicts will lie, cheat, and steal from work and family and these crimes are typically fueled by the search for the next dose. The addiction to these opiates is strong, it overwhelms common sense, respect for others, and simple human decency.
There is Hope
Cannabis is different and new research is showing this plant can help turn this deadly course in a different direction.
Methadone and suboxone have become common therapy in narcotic addiction recovery period surely cannabis is a safer alternative to any opiate. No one has ever died as a result of chronic cannabis use, and there are no known overdoses from acute use.
Chronic use does not carry the widespread organ damage risks well recognized from both alcohol and chronic long term narcotic use.
Studies are early and we need much more research, but the early returns show great promise. We are witness to the results in our clinic daily, with reports of diminished use of prescription narcotics being routine for our patients.
It’s not time to sit back, but a time to stand tall and speak loudly. We clinicians must educate and advocate on behalf of our patients. Cannabis holds major promise to future Wellness for many whom are living a greatly diminished capacity of life.
Opiates: By the Numbers
191 million
In 2017, health care providers across the United States wrote more than 191 million prescriptions for opioid pain medication. That’s a rate of 58.7 prescriptions per 100 people.
Data from the Center for Disease Control
75%
Of those who began abusing opioids in the 2000s, 75 percent reported that their first opioid was a prescription drug .
Data from the National Institute on Drug Abuse
62 million
Worldwide, about 275 million people (or 5.5% of the global population aged 15-64 years) used drugs at least once in 2019. Among them, about 62 million people used opioids. About 36.3 million people suffered from drug use disorders in 2019
Data from the World Health Organization
47,600
Opioid-involved overdose deaths rose from 21,088 in 2010 to 47,600 in 2017.
Data from the National Institute on Drug Abuse
