Sit for a short time with a group of addicts discussing how their addiction began, how they sustained their habit, or the treatment approaches that have failed, and the discussion will probably include disparaging references to doctors. Increasingly, the medical profession is identified as part of the problem and the unabashed promoters of weak solutions. Few will go as far as Steven Tyler, the Aerosmith spokesman in recovery, who recently described doctors as the “new dealers.” However, the consensus is that doctors too often end up on the wrong side of preventing and treating addiction.
Mary is a school teacher in her 50s who blames her doctor for her addiction to drugs. She was injured in a car accident and describes how her doctor gave her opiates to manage pain. He never discussed with her the addictive properties of her prescription, or the importance of transitioning as rapidly as possible to non-addictive approaches of pain management. “When I told him the pain was not going away, he just kept increasing my dosage. If I ran out of pills before it was time for a refill, the doctor at the pain clinic would write me a second ’scrip. By the end of the first year, I realized that I had become an addict.”
In the effort to address acute and chronic pain, depression, anxiety, insomnia, and ADHD, doctors are constantly facing the risk that they may be prescribing the medication that begins the path to addiction. All too often they “awaken” an addiction that may be in recovery by prescribing a medication that has mood-altering characteristics. Give an addict or alcoholic a medication that changes the way they feel and you stimulate their disease. Addiction is often described as a “sleeping tiger,” ready to strike at a moment of weakness. During the past year, we have treated a number of alcoholics at St. Joseph Institute who had been in recovery for many years and then relapsed following the use of prescribed opiates for injuries and minor surgery.
While doctors can be accused of over-prescribing, giving addictive medications to people with a history of addiction, or not carefully educating their patients on the dangers of addictive drugs, they are often the victims of carefully planned deception. “Mark” has spent hours reading WebMD and the online resources of the Mayo Clinic. He knows the symptoms that justify a prescription for an opiate or benzodiazepine. His ability to fake pain or emotional distress evokes comparison with a Broadway actor. Mark estimates that he has been to the emergency room almost 50 times, and has “never failed to score” the drug he was after.
A reality that must concern all of us is the amount of available prescription drugs that are not used by the patient. The CDC has documented how more than 50 percent of the drugs being abused come from a friend or relative.
Source: Centers for Disease Control and Prevention
Too often these drugs are from medications that are being over-prescribed. Dad gets a 10-day prescription of Percocet for a sprained ankle and stops using them after three days. The bottle sits in the medicine cabinet until his son sees it and shares the remainder with his friends. Addicts tell us how they like visiting grandma, because she often has left-over pills in her medicine cabinet that can be used or sold on the street. In the face of 500,000 emergency room visits each year for prescription drug overdoses, there is the need for great caution. When it comes to mood-altering and addictive medications, it may be better to prescribe too few than too many.
The other area in which doctors are vilified by addicts is prescribing medications to manage addiction. There are an estimated 500,000 opiate users taking Suboxone or anti-craving medications. For many, it keeps them away from drugs, but it does not help them establish the habits, and make the changes, necessary for sustained recovery. Rather than lead toward a drug-free life, too often these medications become the “fix” that works until someone stops the prescription, only to rapidly tumble back into addiction. Users often describe Suboxone, Naltrexone, and Vivitrol as “Band-Aids” – an excuse to avoid the real work of recovery. Many Internet articles claim that a Suboxone doctor makes $15,000 a month treating 100 patients, fueling the perception that doctors are not concerned about addressing addiction, but only the potential money to be made.
When we pull together the pieces of the addiction puzzle, doctors do not get painted in a good light. Too many people are addicted to prescription medications, it is too easy to get a ’scrip for your drug of choice, there is too little patient education about addiction, and prevention is an unaddressed topic. However, I suggest it is unfair to paint the medical profession as the only bad guy. Blame can and should be widely shared.
In considering these issues there is a need for a new approach to addiction treatment and the development of new models for recovery. Too often doctors, treatment providers, and community groups work in isolation from one another. With more than 23 million Americans with an active addiction, and only 10 percent receiving treatment, we are all failing in some way to bring this epidemic under control. Now is the time to work together, engaging in dialogue to develop better solutions. We need better answers, and we need them now.
Michael Campbell is the President and Co-Founder of St. Joseph Institute for Addiction, a rehab program near State College, PA that is recognized for innovation and a personalized approach to treatment – www.stjosephinstitute.com.