Lloyd I Sederer MD, with my thanks to Dr. Mark Leeds (www.drleeds.com)
Source: Stencil
The Nature of Drugs of Abuse
The fastest ways to deliver to our brain a drug of abuse, like heroin, fentanyl, crystal meth, and cocaine are by injection, smoking, and snorting. Shooting up, releasing a drug by a needle into a vein, produces an almost immediate high, as does inhalation (smoking). Snorting takes about 5 minutes and ingestion (swallowing) takes near to thirty (30) minutes.
The faster the delivery of a psychoactive substance to our brain, the greater its pleasurable impact and its relief from the misery of withdrawal (or both): fast means more like a hammer than a stick.
Addiction may start with a prescribed pain or anti-anxiety pill like OxyContin (oxycodone) or Xanax (alprazolam). But the trajectory is predictable: pill (or patch), snort, inhale, and inject. A drug dependent person soon (often in weeks) discovers “tolerance”, when it takes more of a drug or a faster delivery method as the ‘answer’ to getting high or blunting a dreadful withdrawal.
In 2017, The President declared the “opioid crisis” a “public health e--mergency”. He later said, “This epidemic is a national health emergency.” The raging epidemic had finally been recognized -- but not truly because a public health emergency is different from an epidemic; it provides no new money, as I described in The US News and World Report.
Declarations notwithstanding, the gravity and magnitude of the epidemic in our country has grown. The numbers of overdose deaths continues to climb. Drug addiction is no longer a problem for inner city people of color: it now is among our family members, friends, co-workers, and neighbors (see Dopesick by Beth Macy https://a.co/d/8pyZ8oV and my book, The Addiction Solution).
Overdoses and Overdose Deaths
A new “tracking” report by the Kaiser Family Foundation (KFF), gives us a mournful account and analysis of the deadly drug epidemic in the US.
The Centers for Disease Control and Prevention (CDC) had released provisional data on drug overdose deaths across our nation. Their early estimates were of 110,000 drug overdose deaths in the 12 most recent months they could track. This is the highest number reported, ever.
The unending and deadly reach of the US Drug Epidemic
The KFF builds on the CDC data to drive home the pervasive and catastrophic effects of our persistent drug epidemic. Its deadly tentacles have touched “two thirds” of families with a loved one suffering from addiction. It was no longer eclipsed by the Covid Pandemic.
The increase in the annual drug overdose body count is further darkened by the prominent role of substance use disorders in the growing numbers of chronically homeless people, evident in about every city in the US. Addiction also is a driver of incarceration, with the US having the highest number of per capita prison cells on earth, with its disproportionate effects on people of color, as reported by the Federal Bureau of Prisons.
Addiction, like Covid, drains the resources of first responders, emergency and intensive care doctors and nurses. Many are fleeing their jobs, experiencing what is now commonly called ‘burnout’.
All this bad news that won’t go away begs the question: why has the US been unable to end, even mitigate, its drug epidemic? We ended the smallpox, polio, and HIV/AIDs epidemics, even reduced smoking and motor vehicle accident deaths, yet still are failing with addiction.
Because we have persistently and insistently pursued the wrong strategy
Supply Side Strategies of Control and Punishment
The supply side strategy to addiction has failed, again and again, for over 100 years. Yet it continues to dominate US actions aimed to reduce the broad and deep consequences of drug addiction. It seems a folly that we are losing this ”war”.
Why? Because a supply side strategy aims to control the supply of drugs in our country and punish those who become addicted. We are spending a whale of amount of money with no real effect: overdose deaths and homelessness have reached new ‘highs’.
Remember Prohibition? With its brief life span, while what has lasted is the mafia, organized crime, succeeds because it gives people what they want. The mafia appreciates that we humans will find a way to get what we want. That’s a business opportunity not to be missed.
Demand Side Strategies
Long-term studies of addiction demonstrate that people do recover from addiction. Though at different timelines and by different methods. But they do recover, which speaks to a demand side approach to addiction without reliance on the criminal justice system.
Treatment for addiction works. But good treatment is terribly inaccessible, and usually unaffordable. Quality is uneven at best. Opinion trumps scientific knowledge in the culture of many addiction centers.
What Can Be Done
Imagine repurposing for treatment the billions of dollars spent on destroying crops, border and port interdiction, “buy and bust” on the street, law enforcement (cops and courts), and the massive (principally) for-profit prison systems. Imagine sparing many families the heartache of grief as well as their guilt and self-reproach in the wake of a fatal drug overdose.
We can save lives and money by putting aside supply-side drug strategies and upgrading the quality and quantity of drug treatment. But not until we have the spine to defund (and repurpose) the useless addiction strategy of control and consequences, which mostly serves politicians, for-profit rehab services, and prisons. But does not serve people in the hellhole of addiction (and their families).
I hope so. I hope Winston Churchill was right when he said, “You can always count on Americans to do the right thing - after they've tried everything else.”