Prescribing Addictions

The United States has been waging a “war on drugs” for the past 48 years: writing laws in a foolish attempt to ban the use and distribution of substances that have been deemed unacceptable. As we have recently discovered with the current push to legalize marijuana (due to its numerous health benefits and other applications), the government’s track record regarding what should be legal is disastrous. It is amusing to me that the government allows opioids—some of the most addictive substances available—to be prescribed, while marijuana—a non-addictive drug with far more medicinal properties—has been banned since 1937.

Opioids are frequently prescribed as pain medication due to their effectiveness at binding the receptors in the brain and spinal cord, thus blocking the feeling of pain. This creates a feeling of euphoria, or a high, that is incredibly addictive. In 2016 alone, doctors in the United States wrote over 214 million prescriptions for opioids. In the same year, more than 11 million people abused their prescriptions, and, on a daily basis, approximately 1,000 people were treated for the misuse of prescription opioids. Georgetown Behavioural Health Institute states that, on average, 116 people died each day in 2016 of opioid overdoses.

While 11 million is a small number when you consider that 214 million prescriptions were written, more than 40% of all opioid-related deaths in 2016 involved prescriptions. That percentage does not include the number of people who started abusing their prescriptions but then moved to using heroin and overdosed. According to the National Institute on Drug Abuse, approximately 80% of heroin users first abused prescription opioid drugs. In 2017 alone, 15,842 people died from heroin-related complications.

Keep in mind that the numbers above are based only on data from the United States, where the population was about 323.4 million in 2016. So, of 323.4 million people 214 million were prescribed opioids. Let me say that again: more than 66% of the United States’ population was prescribed opioids in 2016. This can be partially attributed to doctor’s susceptibility to marketing tactics employed by pharmaceutical companies. According to studies conducted by JAMA Internal Medicine, the number of free meals a doctor receives from a drug company correlates directly with their likelihood to prescribe said company’s products. Not only that, but companies have begun marketing their opioids as moderate and non-habit forming—without any proof to back up their claims.

According to the Centers for Disease Control and Prevention, the opioid prescription rate dropped to about 58% of the population in 2017. That means of the 325.7 million people “legally” residing in the United States, 188.9 million were prescribed opioids. However, the number of opioid-related deaths has continued to increase despite the drop in the reported number of prescriptions written. In 1999, about 8,048 people died of opioid overdoses; in 2007 that number more than doubled, with 18,515 deaths attributed to opioids. Then, in 2017, the number of deaths was 47,600—more than double the number from ten years prior.

The opioid epidemic is largely seen as a problem that affects all groups of people equally. However, the Centers for Disease Control and Prevention considers people on Medicaid or people in low-income situations to be more apt to misuse or overdose on prescription medications.

They cite reasons such as the quality of healthcare to which they have access. People who are on Medicaid (a government program that “aids” with medical costs for people with low incomes) are more likely to be prescribed opioids, both in higher dosages and for longer periods of time, which exponentially increases their chances of becoming addicted. The National Institute on Drug Abuse references a study done by scientist Michael Nader that showed male monkeys that were lower on the social food chain displayed higher addictive tendencies than those that ranked more highly in their group. The Institute states there is also evidence to support the hypothesis that social outcasts are more likely to experience drug cravings than those who have strong social bonds.

As with any addiction, jail time is neither the answer nor the cure. So, that leaves the question: how should we deal with those who are addicted to opioids or other substances? Do we demand more government-provided health care or a social worker for those who suffer from an addiction? Do we allow the government to force these people to seek help? Or do we leave it up to those who are suffering to seek help for themselves? Well, the answer that best respects individual liberties is allowing people who suffer from addiction to seek help on their own. Government interference has proven to be quite useless thus far, especially regarding the use of drugs. As I mentioned earlier, the Centers for Disease Control and Prevention states that Medicaid users are more likely to be prescribed in high dosages and over extended periods of time. I don’t really think another government program is going to fix the way doctors are treating people, especially if those doctors are in the pockets of the drug companies. We allow alcoholics and cigarette smokers to seek help when they are ready, why do we not allow the same freedom to those who are addicted to opioids?

Nobody has the right to tell someone else what they can or cannot do with their body. This includes, but is not limited to: drugs, alcohol, tattoos, piercings, sex, abstinence, makeup, cosmetics, surgeries, gender modification processes, exercise, and dietary choices. While I don’t like drugs (aside from marijuana), it is not my place to dictate whether or not someone else should be allowed to use them. Many people share the common misconception that, if something is bad for you, the government needs to outlaw it. It is not the job of the masses to protect individuals from themselves.

The opioid epidemic has been declared a public health crisis; between 1999 and 2017 about 400,000 people have died from opioid related causes. Unfortunately, this number is still on the rise and is not likely to stop any time soon. With an average of 130 people per day overdosing on opioids (both prescribed and legally obtained), it does not show any signs of slowing down or improving. All we can really do is offer compassion and help to those who are suffering and hope they accept it.

Haley Kennington (Conservatism) Rebuttal

Does Medicaid Help or Hurt The Opioid Epidemic & Possible Holistic Solutions

I find it very interesting that the CDC cites low-income individuals and those living in rural areas as the demographic more likely to misuse or overdose on prescription medications. Considering the CDC states that those on Medicaid are prescribed opiates at twice the rate as those with other forms of insurance, it’s really no surprise that they would be more likely to overdose or misuse said medications. With the increase in prescriptions, there is also an increase in documented cases of addiction, and opiate-related deaths.

It does raise the question of whether prescribing opiates to patients on Medicaid at twice the rate as non-Medicaid patients was always part of the plan or not. Was this demographic purposely targeted knowing full well the addictive properties opioids have, knowing there would also be an increase in drug related deaths? How many of the Medicaid recipients were already in poor health or had mental health issues such as depression when prescribed said opiates? Was that even a factor? Was this demographic targeted because those prescribing the drugs knew full well the outcome?

In February 2018, the latest data from the federal Agency for Healthcare Research and Quality claimed that Medicaid expansion in selected states increased the amount of insurance coverage provided to those with OUD’s, or opioid-use disorders. Though I don’t agree with the terminology used, I think we can all agree that anyone who is addicted to opioids certainly has a problem, though I personally wouldn’t brand it a “disorder,” but I digress.

The study goes on to present evidence that in the states with expanded Medicaid coverage, opioid-related hospitalizations fell dramatically, and added that “Medicaid is part of the solution to the opioid crisis, not a cause.” It also states that Medicaid expansion allows for better access to drugs like Methadone or Suboxone (buprenorphine), which are often used to combat opiate addiction.

Though the articles that I’ve read say drugs such as Suboxone/Subutex and Methadone have a 60-90% success rate, increasing the longer the addict takes the drug - I disagree. The addict is still physically and psychologically addicted to these replacement drugs meant to wean an opiate addict off completely, so the cycle continues. Each day, the addict must take the replacement drugs (that hit the same receptors as opiates) in order to avoid slipping into physical withdrawal. The addict remains a slave to a drug, just a different one than opiates.

There is not one single solution to the opioid epidemic, but I would like to see more research done on kratom, marijuana and other holistic options that help those who suffer from chronic pain, without any physical addiction. Many former opiate users have discovered alternative options such as these that along with physical exercise have greatly increased their quality of life. As the opiate crisis has proven, sometimes doctors don’t always know best, and they can be just as easily persuaded or mislead as anyone else.

© 2018 by Zink Publishing Inc.

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