The cultural definition of insanity is doing the same thing while expecting different results. In the politics of opioid addiction, the culture of insanity apparently rules. I say this because it is obvious that we keep making the same decisions of separation, stigma, and incarceration for addicts, even as the problem of addiction and death from opioids grows exponentially worse.
Opioid addiction is a national crisis. We know that. We know overdoses are killing more people per year than ever before, and we know that fact is so unacceptable that we have declared opioid addiction a national emergency.
Opioids by the Numbers
- Between 1999 and 2010 US opioid prescriptions quadrupled.
- Between 2000 and 2014 US opioid deaths also quadrupled.
- By 2010 there were enough opioids prescribed to provide every single adult in the US with six 5mg pills (1 every 4 hours) of hydrocodone per day for 30 days.
- It costs the US citizens $56 billion per year to combat opioid dependence.
- 1 out of every 3 prescriptions are being abused.
- Baby Boomers are more likely to abuse opioids than millennials.
- Every day in the U.S., 175 people die from opioid overdoses.
- According to Express Scripts’ study, “A Nation in Pain,” 50% of opioid users are on short acting opioids which increases the risk of addiction and 60% are on other drugs which make opioids more dangerous.
- According to a Muhuri et. al. study in 2015, 79.5% of heroin users reported using prescribed opioids before ever using heroin.
- 45% of people using heroin are addicted to prescription opioids as well.
- Between 2002 and 2013 opioid use increased by 286%.
- Approximately 75% of overdoses nationwide involve opioids.
- 7000 people are treated in the ER every day for problems related for prescription opioids.
- 1 in 20 people use their prescribed opioids for other reasons than prescribed.
The following statistics will come as a surprise to most people. We know about the drug war, and we know the body count is piling up. The media would have us believe it is mainly from illicit drug use, but the statistics show a different story. Currently, according to the CDC, prescription overdose deaths outpace heroin deaths. It’s a fact we cannot deny. (Note: The synthetic opioid overdose rate is not broken out into prescription vs. illicit synthetics; it states the data excludes methadone but includes “drugs like tramadol and fentanyl – prescribed fentanyl and illicitly manufactured fentanyl,” therefore the assumption is that synthetics carry a very similar ratio to the non-synthetic brands.) Regardless, they are all within approximately 2,000 deaths of one another.
If we are to believe the data, it would appear the medical community is weighted a bit heavier on the scale of responsibility. Does that mean that with the newly expanded War on Drugs we are to believe we should also charge, try and convict our medical community with capital punishment as we are threatening the dealers? Of course not! There have been enough deaths surrounding this issue and compounding it with capital punishment is not the answer. The problem is much more complex than that, and it requires a complete retool of the system, including the way we look at healthcare and alternative methods.
The Paradigm Shift
One of the hardest things for people to do is change the way they view something. It becomes more difficult when we begin to understand that the prescribed solution to a problem often results in losing the person we are trying to save. This is especially true as it relates to illness or disease, managing traumatic or chronic pain, mental health, and addictions.
As patients, we simply have to reduce or better yet, refuse the opioids and begin legally utilizing an incredibly safe drug like the cannabis plant. Cannabis can ease that process mightily without adding other addictive and dangerous drugs like Suboxone and Methadone as it treats our pain.
We are raised to trust the medical professionals, law enforcement, and our government, but we have failed to study the basis of those hand-me-down beliefs and if they still apply. The sheer fact that we have fought the war on drugs for over 100 years, while at the same time raised empires on legal addictive drugs is simply stunning.
Now in 2018, we are doubling down again. We have shunned, separated, and imprisoned so many people who were ill with one or more of the above conditions; threw mud on them; and called them dirty for the rest of their lives – and those are people mainly of color. We believe “tough love” and “disassociation” are the only ways to handle addictions and it’s frankly a little insane to believe that any social animal will respond favorably to being locked down and shunned. It’s amazing the recovery level of 5% even exists for these people, and in actuality it goes strictly to the will to live of those individuals. This practice has done nothing to fix the problem, but it has killed or ruined the lives of those struggling with drug addiction and their families.
The paradigm shift is getting very real as we realize we have all been duped and the “done thing” is not always the best way to do things. This applies to the government, the medical complex, law enforcement, citizens, and patients.
"Don't Look for Zebras"
To starkly highlight the condition our medical complex is in I will share a story with you. This story has stuck with me and changed my personal approach to healthcare, and I encourage you to watch it in full. Several years ago, while struggling with my own illness, I was given a video by a friend on Bl2 deficiency wherein one of the cameos was a physician who has a very dramatic story about becoming a patient himself due to an undiagnosed B12 deficiency. This deficiency nearly killed him and in fact did permanently cripple him. B12 deficiency is a sneaky and insidious problem that left unchecked, will kill you.
In this video, the physician/patient made an astute observation concerning his training on diagnosis techniques. He stated that as a med student he was taught diagnoses by a simple axiom that if he “heard hoof beats, look for horses, not zebras.” Through his rapidly deteriorating condition, he found that even as a physician practicing for many years who had many physician friends who tried helping, he had still fallen through the cracks of diagnosis. All of the physicians involved in diagnosing and treating his illness, including the patient himself, had missed this terrible life-altering deficiency because of that single premise, “don’t look for zebras.” This doctor was given a death sentence, a very rare neurological diagnosis based on symptoms. He literally came to within days of dying before one physician friend dramatically and bodily carried him into Shands Hospital in Gainesville where finally someone correctly diagnosed his deficiency.
All the Neurontin and opioids in the world were not going to treat a serious deficiency like that, yet how often do physicians begin a diagnosis routine with examining your blood serum and tissue samples testing for proper nutrition on every level?
I tell this story as an introduction to say we don’t know what we don’t know, and we can’t find out what we don’t test. We certainly can’t simply build huge complexes so involved with human lives and not check, test, and ensure it is still meeting the needs of a complex and aging society. Such is the case with our over-the-top opioid problem.
The Hippocratic Oath
We all know physician training protocol includes, “First do no harm.” In fact, that is the Hippocratic Oath physicians swear when receiving their license to practice medicine, and it’s the basis of where the term “harm reduction” comes from. Harm reduction simply means substituting safer treatments for lethal ones. Diagnosis, symptom relief, and disease modulation are the three pillars of healthcare and physicians are sworn to use the least damaging of methods to achieve the goal of wellness for their patients. Given that there are enough prescription opioids prescribed in a year to give every adult in America a 30 day supply of 5mg hydrocodone, it would seem the goal of harm reduction is in a losing battle.
Big Pharma, Big Problem
In addition to “hoof beats” and “do no harm.” accepted U.S. medical practice includes an extremely unhealthy dependence on drug manufacturers to present the treatment possibilities, to train physicians on their use, and purportedly be honest about the side effects and efficacy of the drugs they are selling. The key word here is “selling.”
Pharmaceutical companies aren’t in the game of developing drugs to not have them be used, and they aren’t in it for educating physicians. They are in the game to sell the drugs they make. They sell drugs to mediate a symptom that then causes another system to break down so they build drugs for that, ad nauseam. If that seems somewhat sinister, it is. Even technological advances can get to the place they cause negative returns.
Pharmaceutical reps have families to feed too, so they hand deliver a free lunch and samples of drugs to medical staff, gift trinkets like display models of organs or skeletons, etc., wine and dine the physicians as they train them to use the drugs they are selling, and pay physician’s fees for various things. Many of these drugs, if the commercials are to be believed, are worse than the symptoms of the disease they were developed to modulate.
Our system at its core, as it turns out, teaches and encourages physicians to look for horses and depend on the snake oil hucksters to provide the products to modify the horse. Yes, that is simplified fact for word count sake, but it isn’t hyperbole. The system is very horribly broken and many of us are dying as a result. Thankfully, federal law did force public disclosure in 2013 so you can now research your physician on ProPublica and OpenPayments found in the links below.
Coupling these truths with the fact that at only 5% of the world population the United States consumes 80% of the world’s prescription opioids, we can possibly begin to see where the glaring problems in our system lie.
And Bigger Problems
If we simply throw pharmaceuticals at problems without discovering root cause, we only create bigger problems. Once a patient is on treatment, even if that treatment is not working, they are afraid to get off said treatment for fear of the problem becoming worse. If the doctor says to give it time, more often than not, it’s time they will give. They grow dependent on treatments that aren’t fixing the problem, just semi-managing the symptoms. If this is a pain treatment, and the patient gets hooked, they ask for more because their tolerance to the drug is growing higher and the dosage is no longer working. This is a natural response of the body as it tries to maintain homeostasis.
When a patient asks for more or is resistant to a particular medication, we tell them they are addicted, call them a drug seeker, and all too often kick them out of pain treatment as we watch them either sink or swim. This is called “red flagging” a chart and it classifies the patient as a drug seeker and follows the patient the rest of their life. If they swim it’s generally because they have means to try more safe and natural methods, but if they sink, well that’s a different story. Sinking means replacing their prescribed drug with someone else’s prescription or an illicit substance. We react badly to such a natural survival technique, so through arrest or family pressure, we either put them through 110-year-old white-knuckled abstinent treatment programs or we imprison them. These programs specialize in sequestering away the addict in lock-down programs for 30 to 45 days of intensive treatment which oftentimes comes with lots of berating and yelling, certainly loss of freedom, and is typically followed by an additional 6-12 months in a limited liberty halfway house.
Our options, according to lore, are cutting them off from home, friends, family, and society. If they are caught with ill-gotten or illicit meds we imprison them; all of which have less than a 5% chance of recovery for the addict and are fraught with life and career changing problems. One problem becomes four or five problems.
There has to be a better way
The research for better and more effective ways to treat addiction are there in many studies and methods, but few more promising than the Rat Park Study and the very real life example we have in what has become known as the Portugal model. These two real life examples show us very clearly that addiction can be both helped and resolved when we place the onus on liberty rather than incarceration. With that knowledge, we still choose the model of isolation and stigmatization rather than the hard work of long-lasting change. In part, we do this because of fear and loathing and we end at the place that that says “this is the way things have been done for 100+ years.”
The cultural memes of our day are downright hateful to addicts. We fear and don’t like addicts whether or not they have ever harmed another. We call them names. We stop viewing addicts as human and start viewing them as animals, shut away the addict, cripple them with felonies and jail time, ostracize them and make them feel ugly. I find that very odd as most of us have loved ones who are addicted to something, and if statistics are to be believed, quite possibly many of us are taking the same class of medication we despise them for.
As humans, we often take the easy path we’ve been taught rather than to think about the problem and make adjustments and course corrections. Because we do not understand or believe other methods, or we remain ignorant and lazy on the topic, we all too often lose the game and this game comes with a very heavy cost. With stakes as high as these, we can no longer afford the cost of the worn path and must begin blazing new trails. Cannabis is one such answer.
Cannabis has proven to be very successful in withdrawing off opioids and there are myriad studies and real life anecdotes to support this fact. For instance, in states that have a robust cannabis programs, opioid overdose and death has fallen by 20-25%.
It’s important to realize, opioids build tolerance as the body seeks homeostasis, and patients ask for more at this juncture because the original dose isn’t working. Opioids are addictive and can easily kill you. Cannabis builds tolerance while enhancing homeostasis and cannabis users can go off for a few days and drop tolerance down without any ill effects. It is less addictive than caffeine and about equal in detox to caffeine withdraw!
So what is the solution? We can’t leave pain patients suffering, but we do need to switch our focus on disease and illness. First do no harm. Focus on true harm reduction by first looking at our body’s needs, deficiencies, diet, and all hoof beats, not just those of the horse, and learn to utilize more natural and plant based products, including cannabis, first before going the route of pharmaceuticals, especially the addictive ones.
I will leave the readers with this. There is help. There is hope and if you need someone to talk to, I am available to help coach you through this process. I’ve lived it with family members and I know it works.
OPIOID USE COMBINED WITH CANNABIS
An Israeli study titled Haroutounian et. al.2016 on cannabis for treatment resistant chronic pain:
- 176 chronic pain patients were given 20 grams
- 73 of these patients were on opioids and the rest were on analgesics
- These patients were given titration instructions to start low and slow with cannabis and to take the cannabis 3 times per day while trying, if they could, to start lowering their dose of prescriptions whether analgesic or opioids.
- 44% of the 73 opioid users stopped using opioids completely and most of the remaining lowered their dose.
- All patients noted improvements in pain and quality of life
A Michigan study titled Boehnke et.al. 2016 held a cross-sectional retrospective survey of 244 medical cannabis patients with chronic pain in Michigan.
- Out of 118 patients, 64% had a decrease in opioid use
- They found a decrease in number and side effects of medications
- 45% noticed improved quality of life
In March 2016 CDC guidelines recommended NOT testing pain patients for cannabis.
A Canada survey, Lucas et. al. 2015 of 473 adults found that 87% substituted cannabis for alcohol, illicit drugs or prescription drugs.
- 80.3% reported substitution for prescription opioids
- 51. 7% reported substitution for alcohol
- 32.6% reported substitution for illicit drugs
- These adults stated the reasons were that cannabis was more effective than their drugs of choice, they had less side effects with cannabis and less risk of addiction and dependency
In a Raby et. al. study, scientists tested addicts in recovery with the choice of taking cannabis and their Naltrexone to keep off opioids found that cannabis improved the number of days in treatment and their abstinence records. Of those who chose to utilize cannabis in conjunction of their Naltrexone treatment:
- 100% of cannabis users returned for their second injection of Naltrexone in one month
- Only 46% of those who chose not to use cannabis with their Naltrexone treatment returned for their second injection.
War on Drugs: www.history.com/topics/the-war-on-drugs
B 12 Deficiency: www.youtube.com/watch?v=BvEizypoyO0
Doctors on Drugs: web.archive.org/web/20130201030306/
ProPublica: Cnn.com/2017/05/ 17/health!addiction-cannabis-harm- reduction/index.html
Rat Park Study www.brucekalexander.com/articles-speeches/rat-park/148-addiction-the-view-from-rat-park
Portugal Model: www.youtube.com/watch?time_
continue=l 4&v=PY9DcIMGxMs and www.theguardian.com/news/2017Idec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-worldcopied-it
The Role of Legalized Cannabis in the Opioid Crisis jamanetwork.com/ journals/jamainternalmedicine/article-abstract/2676999
Dr. Sulak’s Cannabis and Opioid Video Guide, the Science healer.com/ cannabis-and-opioids-video-guide-the-science/