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America's Exploding Oxy Epidemic

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By Maia Szalavitz

06/17/11

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In fact, the first time I quit heroin I was surprised at how mild the withdrawal was, given what I’d heard about its horrors. Actually, it was so easy that I picked up again a few weeks later—long after my not-especially-dire symptoms had disappeared! It was that kind of logic—and repeatedly making those kinds of choices—that made me not only physically dependent but an addict.

My addiction was a result of my own decisions; it wasn’t something that mysteriously “happened” to me because I chanced to use heroin. I may have had impaired control over the later choices I made, but it was nonetheless I—not a dealer or a doctor—who made those decisions for me.

Studies regularly show that the odds that a person with no prior history of addiction will become hooked on prescription opiates are incredibly small, rarely reaching even 3%. In a recent study of some 5,000 pain patients who took prescription opioids for more than six months, a mere 0.27% showed any signs of addiction. Former addicts, of course, have greater odds, but most can be safely treated with opioids if there is no alternative to relieve their pain. The drugs by themselves do not inevitably trigger a relapse or wreak havoc with recovery.

And if they don’t make repeated choices to abuse the drugs by upping the dose or frequency, or popping them recreationally, people can’t “accidentally” slip, as if on a banana peel, into addiction.

To an opioid aficionado like me, it comes as a shock that most people actually don’t like the feeling they get from these drugs: research on normal volunteers who aren’t in pain finds that they typically don’t enjoy the experience. And about one third of subjects in clinical trials and other research on opioid use for chronic pain actually drop out due to side effects—a fact that doesn’t exactly square with the popular view that the drugs are irresistible or instantly addictive. There's no doubt that addiction to opiates is growing. But in the larger scheme of things, opioid addiction is relatively rare. Oxycontin is not an unconquerable demon that destroys in its path. People who are addicted to Oxy are generally pre-disposed to other addictive behaviors. But if we continue to try to fight the problem by ignoring this fact, we'll end up hurting pain patients who really need the drug, while doing little to help Oxy addicts.

3. Even physically dependent soldiers mostly don’t become lifelong addicts.

During the Vietnam War, Department of Defense officials were shocked when they learned how many U.S. soldiers had become physically hooked on heroin and opium while serving. But just as shockingly, they discovered that the vast majority did not become re-addicted when they returned home. To those raised on heart-rending images of homeless junkie vets panhandling on the streets of America, this fact may be hard to believe. What’s generally ignored but genuinely surprising is the very high proportion of combat vets who used heroin during their tour.

A study of nearly 900 returned vets conducted Dr. Lee Robins, a sociologist and psychiatrist at Washington University in St. Louis, found that a full 50% of U.S. soldiers tried opium or heroin in Vietnam—and 20% of those who tried these opioids under the highly stressful conditions of war±took them to the point of becoming physically dependent.

But stunningly, just 1% continued to use to the point of addiction after they returned home, even though a few did take heroin once or twice in America. Though they used opioids recreationally under high stress circumstances at a period in life when addiction risk is highest (late adolescence and young adulthood), an overwhelming majority of the soldiers did not become lifelong addicts.

The same will likely be true of our Afghanistan and Iraq war vets—though the repeated tours of duty they undergo could increase their long-term addiction risk.

So what does all this mean for the “painkiller epidemic”?  The good news is that opioid addiction is relatively rare, even when large numbers of people are exposed to these drugs. The bad news is that we continue to try to fight the problem by ignoring this fact. Virtually all of the Obama administration’s major news initiatives are focused on “educating” doctors and tracking their patients and prescribing. But given that most addicts aren’t patients—and most patients aren’t addictd—this makes little practical sense.

If we want to develop drug policies that work, we need to base them on what addiction is really like, not on the stereotypes the media presents or on stories told by addicts who are spotlighted because they represent those stereotypes. The media also needs to stop exaggerating the size of the problem to make the story seem more important.

Next, we need to find out what makes people who get hooked different--what makes some people compulsively use certain drugs despite the damage they know they will inflict on their lives? Trying to prevent opioid addiction by eliminating access will never work because the very people who are most dedicated to obtaining drugs are the least deterred by making them harder to get. We need to make maintenance options available to those who need them and provide treatment referrals—not expulsion from care—when doctors discover misuse.

Otherwise, we’ll wind up following the same misguided policies used to “fight” crack—with the same harmful and ineffective results.

Maia Szalavitz is a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006). Her previous piece for The Fix was An Ex-Addict Aims for Motherhood.

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