Here lately I’ve been seeing a meme going around social
media debating whether opioid addiction is a disease or a choice. I think that is
a topic worthy of conversation. When does it stop being a decision and start
being a disease? When does it stop being a lifestyle choice and start being a
disease? When does it stop being an act of devastation for a family, for the
children sometimes involved and start being a calling for serious, obtainable
help?
It is no secret that there is a history of opioid addiction
in my family. I am somewhat bias to this specific topic. I am always looking
for an answer. Or as we call it in the autism community, that “magic bullet.” That
cure-all. That one answer that will end the pain they feel and the pain they
cause in the wake of their addiction.
Everybody knows that my family has dealt with opioid addiction,
but few know that we once again find ourselves looking for that “magic bullet”
for our loved one. Once again, we find ourselves sitting up at night hoping we
don’t get that phone call. Once again, we start our fight for a loved one's
life. So, yes, this is a deeply personal issue for me. I need an answer. Is it
a choice or is it a disease? Or is it both? This has become a matter of life or
death for someone I can’t imagine living without. I imagine that some of you
find yourselves in the same spot as me. In fact, I know you do. Per the
National Institute on Drug Abuse 115 people a day die of opioid overdoses. This
includes prescription pain relievers, heroin, and synthetic opioids such as
fentanyl. That is 115 families destroyed a day. This is a real issue not a joke
on social media.
Every single day in this country we hear about someone
passed out behind the wheel of their car, overdosed. Or someone found in their room dead
from that last fatal dose of heroin they really thought they could control. Most
of the time their addiction started with a doctor not monitoring how much of a
pain killer they dispensed to their patient. In 3 months’ time my brother was
given over 1000s of oxycodone due to having a broken arm. It was downhill from
there. That was 12 years ago.
We have cities and counties in this country essentially debating
if saving an opiate addict’s life is worth it. They are truly questioning if Narcan
should be administered on repeat overdose patients, or if they should be left
to die. Butler County, Ohio Sheriff, Richard Jones is actually quoted as saying, “It's just reviving somebody who's going to go back and get high the
same day. It's a war that we're losing."
Those individuals aren’t just addicts- they are someone's
child, sibling, and grandchild. They contain somebody’s greatest memories and
somebody’s greatest needs. They are not loss causes, they deserve help- not societal
shunning. So, as I do with most any question I have… let's look at some of the
science and statistics surrounding opioid addiction.
How did this start
With a lie. It started with a lie. According to the Institute on Drug Abuse: In the late 1990s pharmaceutical companies essentially walked
into doctors’ offices and spread misinformation to doctors which subsequently
led to a rise in the prescriptions written for the pain medications. Essentially
then raising the drug companies’ sales. From there is wasn’t long before opioid
overdose rates actively increased. In fact, it is reported that in 2015 more
than 33,000 Americans died as a result of an opioid overdose. It is also reported
that drug manufacturers that encouraged doctors to overuse opioids are now
facing lawsuits for their role in creating the opioid epidemic.
 |
| Number of prescription painkillers written from 1991 to 2013. Picture Courtesy of the Institute on Drug Abuse |
The Science of Addiction
The overdose death toll has grown 532 percent since 2002. Would
it surprise you to know that it now overtakes car crashes as a leading cause of
death? The truth is that no one human is immune to opioid addiction. These
drugs are prescribed by the people we trust the most and they work at the
cellular level. My question is how can this be called a choice when “these drugs
take over a person’s brain outside of the point where they can control the
chemical processes that are occurring. Essentially, addiction seizes a person’s
ability to control their impulses. It is reported that this causes hundreds of
changes in brain functioning.” So, is that a choice?
When you look at the research being done on addiction there
seems to be a genetic link. Per a report by Mr. Gene M. Heyman, Department of
Psychology, Boston College, Boston, MA, USA, “Twin and adoption studies have
repeatedly demonstrated a genetic predisposition for alcoholism and the limited
amount of research on the genetics of illicit drug use suggests the same for
drugs such as heroin, cocaine, and marijuana.” But it is worth mentioning and
was mentioned by this report that “all behavior has a genetic basis, including
voluntary acts. The brain is the organ of voluntary action, and brain structure
and development follow the blueprint set by DNA.”
More research into the genetic links are currently being done.
Genetic mutant mice “lacking various dopamine or opioid receptors, various
monoamine transporters, and various growth factors” are being developed and
tested for their "sensitivity to drugs of abuse." The University of Strasbourg reported work with mice having 3 of their opiate receptors deleted. While
pharmacological studies have suggested there are “subtypes within the
classes of opiate receptors,” the genetic studies call this into question. Let me get scientific on you for a second. This study suggests that “while
the μ opiate receptor appears necessary for the addictive and painkilling effects
of morphine, deletion of the δ opioid receptor appears to augment the effects
of deletion of μ receptors in heterozygote animals with one copy of each gene
deleted. Animals with the μ opiate receptor deleted appear relatively normal,
suggesting that the function of endogenous μ opioids may be largely restricted
to abnormal conditions of stress and pain.” Basically, suggesting a large
genetic proponent to opioid addiction.This study goes a step further to claim that drug addiction is a cause of Brain Disease.
These studies also suggest that opioid addiction can be a form of self medicating for the mentally ill, or for those predisposed to genetic conditions of mental illness. The self-medication hypothesis of addictive disorders comes mostly from clinical observations of patients with such disorders though. Per Harvard, a person with substance use disorders "suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing."
So does self-medicating for a mental illness make addiction a choice? Mental health help is almost as impossible to obtain as rehab and long term addiction counseling is. For those of you questioning how unobtainable drug rehab is for addicts, let me break it down for you...
Drug Treatment Costs in the U.S.A, per the Addiction Center
- Outpatient detox: Out Patient rehab ranges from $1,000 to $1,500 in total. Most inpatient rehabs include detox in the cost of a program. The exact cost of detox depends on whether it’s part of an inpatient program and the type of drug addiction being treated. Substances with dangerous detox side effects require more careful monitoring, making the price higher.
-Inpatient Rehab: Some inpatient rehabs may cost around $6,000 for a 30-day program. Well-known centers often cost up to $20,000 for a 30-day program. For those requiring 60- or 90-day programs, the total average of costs could range anywhere from $12,000 to $60,000.
-Outpatient Rehab: Outpatient programs for mild to moderate addictions are cheaper than inpatient rehab. Many cost $5,000 for a three-month program. Some outpatient programs, such as the program at Hazelden Betty Ford, cost $10,000. The price tag depends on how often the individual visits the center each week and for how long.
-Medications: The type of treatment and medications needed affects the price tag on rehab. Some people don’t need medication for their addiction. Medications most often treat alcohol and opiate addiction. It can cost several thousand dollars a year. Year-long methadone treatment for heroin users costs around $4,700.
How does anybody expect a middle class family to be able to afford treatments with costs like that? You should also keep in mind that even with treatment some 91% of addicts will relapse.
So, does having a genetic predisposition to addiction make it a choice? Where does that fine line lay that distinguishes the difference between the two? Yes it is their choice to take that first pill, but by default does that make the whole addiction their choice? When do they cross that line that makes it no longer a choice and makes it a desperate need for them to get help?And when the hell did we get the gull to question whether a person's life is worth saving simply because they may use again? Every life is worth saving.
There is another point to this question and this meme going around... Has claiming it is a choice made the situation worse? I read an article while researching for this that said it all to me. It stated that, “Falsely characterizing addiction as a moral failing led to another epidemic — the epidemic of silence that so often surrounds overdose deaths. The stigma and shame imposed on family and friends and the pressure to attribute the deaths of their loved ones to accident or suicide has allowed the opioid crisis to flourish in secret: Americans haven’t understood the enormous scale of this crisis until recently.”
So is it a choice or a disease? To me, I think it is both. It starts out as a choice, whether made because of a doctor's directions or not, and for some people ends up being a disease that they need immediate help to get past. Jail doesn't help this. Shaming doesn't help this. Truth, care, understanding and long term treatment helps this. When does an addict and their family become worthy of that? It seems to me that to some, sadly understanding and care only comes after opioid addiction touches their lives.
Want to read more from Brooke?
Sources:
Opioids are:
ReplyDeletePrescription drugs, such as hydrocodone (Vicodin®),normally used to treat torment,Illegal medications,for example- heroin
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