Last week, I received an official letter from the Maryland Department of Health and Mental Hygiene (DHMH). “Dear Colleague”, it began, “we are writing to ask for your help”.
The DHMH needs my help to combat fatal drug overdoses, which have been rising at an alarming rate, though not exactly in the way everyone thinks. While overdoses from prescription pills have decreased due to increasing crackdowns, doctors and health officials have noted a corresponding rise in the deaths related to heroin and other illicit drugs. Almost, as the letter explains, as if the patients who are being denied their prescription drugs are turning to other, illegal sources to get their brain-chemistry fix and avoid withdrawal.
The only thing that surprised me in this letter was that I didn’t receive it five years ago.
You who read this blog know that I’ve been writing about these issues for years. It’s fascinating to watch society move through the stages of acknowledging this problem that I’ve been immersed in for so long. In one sense, it’s heartening to finally see people in positions of authority start taking the addiction threat seriously. While most physicians I know have been reacting by shutting off access to pain pills, afraid of the liability and harm that comes with addiction, at least they are now recognizing that addiction poses a threat.
On the other hand, of course, I would always like to see us doing more, and doing more constructively, rather than just (as the letter recommends) “considering whether prescription pain patients might be at risk for doing heroin” and warning them about the dangers of illicit drugs. Warnings about the dangers of drugs will not stop addiction, as I’ve repeated here many times. Warnings are for the forebrain, that deals in rational decision-making and foreseeing consequences. Addiction is the mechanism by which that part of the brain is shut down.
Still, this letter makes me think that we are finally on our way to a multidisciplinary, cross-field, state- and nation-wide system for dealing with addiction, like the ones we have set up to manage other pervasive chronic illnesses. The new efforts to monitor prescription drugs across practices and state lines are an excellent start.
Once we have the channels in place to detect addiction, the next step will be to set up treatment systems, places we can send all these addicted patients once we catch them. Maybe, when we get to that stage, we’ll finally see the medical revolution that has been coming in addiction for so long.