Treat addiction as a disease not a defect

THE BOTTOM LINE

  • Physiology and biochemistry - not a moral failing - that causes people to take prescribed pain medications to the point the opioids cause terrible withdrawal symptoms if not taken.

I have followed news of Prince’s death this spring with a mix of anger and insight. While the cause is still under investigation, officials suspect prescription drugs played a role; authorities found opioid medication on him when he died and in his Minnesota home.

From my lengthy experience as a doctor who specializes in the treatment of those addicted to such pain medications, I believe it is likely that he was taking more and more of these medications because of probable withdrawal symptoms until he overdosed and died. And I hope his death inspires people to look at how we treat those with addictions, as much as his music inspired them in life. We need to treat the people who suffer from it as having an illness like any other and not as a personal failing.

Most people continue to believe that addiction is a self-inflicted wound caused by a voluntary behavior and that appropriate “counseling” of the addicted person will result in effective treatment. That belief is the biggest myth of all, often repeated even by treatment professionals who should know better. The fact of the matter is that people develop tolerance to pain medications, become dependent, have intolerable withdrawal symptoms and then eventually end up taking higher doses, even if they start off taking medications exactly as directed.

It is therefore physiology and biochemistry - not a moral failing - that causes people to take prescribed pain medications to the point the opioids cause terrible withdrawal symptoms if not taken.

Medical science has shown one of the brain’s constant goals is to try to maintain a chemical balance. When a high tolerance occurs because of frequent use, and when drug use stops, the sudden, sharp drop in neurotransmitter levels upsets the chemical balance. The brain activates a deep, instinctive drive to get more drugs and restore the higher neurotransmitter levels the brain is now used to having. These impulses produce insatiable cravings. The brain works against the will of the person because the brain is deprived of something it thinks it needs to survive, and the brain’s only goal becomes to obtain that substance again.

Still, society treats those who use opioid pain medications as having failed at a personal level. Even our language shows how we view them. Those who test drug free are “clean.” Those with drugs in their system are “dirty.” We do not view other diseases such as heart disease or cancer in such a way.

Even many common treatments, such as 12-step programs, emphasize that addiction can be treated by relying on a “higher power” to cure it instead of treating it like the medical illness that it is. We do not expect diabetics to rely on a higher power to solve their health problems.

People die daily from a combination of untreated withdrawal symptoms and unintended overdoses.

It is comforting for us to believe that after people cease use of an addictive drug, their synapses and receptor sites repair themselves and the brain returns to its natural balance. If this were true, simple detoxification would allow people an opportunity to recover. Unfortunately, medical professionals know this is not always the case.

With our new understanding of the disease of addiction, we have been able to develop some medications, such as buprenorphine, which can get at the root of the medical problem, at the neurochemical level. These medications offer us a true chance to treat and beat the disease of addiction. However, because of the myths, stigma and lack of proper medical resources, that treatment can be hard for people in need to seek out and to find.

An attorney for California-based drug-addiction consultant Andrew Kornfeld told reporters that he had plans to meet with Prince to encourage the entertainer to enter rehab and begin treatment with buprenorphine, but he was too late.

If Prince, a very wealthy and influential person, had difficulty finding the proper course of treatment in time, or felt it necessary to keep his struggles to himself, think how difficult it must be for people whose disease has already deprived them of financial and other resources to seek out help. Addiction treatment needs to be readily accessible just like treatment for other common diseases.

For Prince, the medicine that might have treated his illness and saved his life was too slow in coming. For those who still live with the disease of addiction and the medical professionals who treat them, it does not have to be. It’s time we started an open and honest conversation about treating addiction before more senseless deaths occur.

Authored By Lee Tannenbaum, The Baltimore Sun