Prescription Abuse and the Legalization of Illicit Drugs

I have advocated the legalization of illicit drugs for a very long time. While my politics and party affiliations changed over the years, the belief that most if not all currently illicit drugs should be legalized has never wavered. Whether taking them decades ago or living the Straight Edge path for going on 12 years, I always believed that America would be a better place as a society if it legalized and regulated marijuana, cocaine and heroin.

Walter Russell Mead challenges that belief by comparing the arguments supporting legalization with the reality of prescription drug abuse. Try as I might I’m finding it difficult to argue with the points he makes. Mead writes, “Legally prescribed drugs are now regulated the way many legalization advocates think illegal drugs should be. The flourishing black market in prescription painkillers and the thousands of deaths associated with their use demonstrate that drug use will not be magically fixed by regulating currently illegal drugs. While legalization advocates argue that putting heroin and similar drugs on a prescription basis would reduce fatalities associated with their use, the high toll from overdoses of legal painkillers suggests that this argument is weaker than often believed.

The statistics about prescription drug abuse, to pardon the pun, are sobering. According to the CDC deaths from legal prescription painkillers now surpass those from heroin and cocaine combined. In 2008, 15,000 died from painkiller overdoses. In 2010 12 million Americans used legal painkillers to get high, and that year enough prescriptions were written to keep every single American stoned for a month. That’s 4x more drugs prescribed than in 1999. Today pain is the most common reason for physician visits in the US.

As with any complex issue, there is no simple solution. Until recently doctors had taken more of a “what we cannot cure we must endure” stoic approach with their patients when it came to pain. It wasn’t until the 1970s that doctors began studying pain and specializing in pain treatment and management. Progress has been slow. The foundation of pain management remains addictive narcotics with broad effects instead of the development of drugs that target specific pain. Worse, when used to treat chronic pain these medications may increase pain sensitivity. Even when pain isn’t chronic it may take months, sometimes even years for the underlying injury to resolve. If narcotics are the main treatment for pain, should we be surprised when a patient becomes addicted to pain medications?

There is a big difference between the perception of prescription pain medications and illicit drugs. Generations have been indoctrinated into viewing crack and heroin as “dirty” and socially unacceptable. It takes years for newer drugs such as methamphetamine and ecstasy to be recognized by society as a threat and subject to a mix of propaganda and truth to stigmatize the drug and curtail its usage. In the 1980s and early 1990s meth was underground and commonly used for all night cram sessions by college students and by long haul truck drivers. Now it has been stigmatized as a cheap high for rednecks a step above huffing paint. Prescription drugs have an aura of acceptability that illicit drugs currently lack but would attain if they were legalized. Legalization presents a legitimacy which in turn implies safety. People may naturally view heroin and cocaine as dangerous and consider Oxycontin as innocuous even though one can overdose on Oxycontin as well as heroin. People believe that because a drug is prescribed by a doctor it is somehow completely safe.

While it is possible that after legalization the negative perceptions of the formerly illegal drugs would remain, it is expected legalization would expand usage and abuse. Those favoring the legalization of illicit drugs need to accept this and modify their arguments to reflect this reality. One way to do this is to focus on the core arguments for legalization such as individual freedom and personal responsibility. In the case of prescription drug abuse, doctors need to recognize the danger of supplying patients with narcotics, including the likelihood that the drugs will fall into the hands of others. It is much easier for a physician to prescribe narcotics than it is to advise patients on non-medication pain management therapies such as deep breathing, meditation and exercise. Those that need more should be sent to pain clinics which specialize in pain therapy (and can be monitored closely by authorities).

People need to be educated about pain. Pain is a reality of life and in most cases such as injury it is an important component of the healing process. Dulling it at every opportunity may feel good in the short term but present long term dangers such as prolonged healing, re-injury or addiction. Similarly people need to learn the truth about pain medications. The narcotics on grandma’s shelves are just as dangerous as those being offered for sale on the street a few blocks down.

The solution for drug abuse, whether illegal or legal, is education along with treatment options offered by for-profit and charities. As far as solutions go it’s a lame one, but the alternatives such as the continued prohibition of illicit drugs and the jailing of addicts is far worse. Far better to increase awareness and encourage personal responsibility.

As a recovering alcoholic with 11 years of sobriety under my belt, personal responsibility is the one key component to wellness that gets ignored in the debate. To those sympathetic to the addict and those who take a hard line against illicit drugs, the addict is powerless to resist the drug so the addict must either be protected from his drug or kept away from it through its illegality. Hardly anyone dares tell the addict “You live in a world with your drug. You can have it and ruin your life, or not and live a decent life without it.” There is proof that addiction has a genetic component. For some it may have an epigenetic basis. But regardless of its origin, whether the addict was born that way or acquired it later in life, one is ultimately responsible for one’s own destiny, not Society.

UPDATE:
A documentary on the Oxy Express. The most chilling documentary I’ve seen in years.
An in-depth series on prescription drug abuse by the Delaware News Journal.

19 Comments

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