Sir William Osler, the father of modern medicine, famously said in 1884, “Humans are distinguished from all other species in their desire to take pills.” How little did he know! Who could have predicted more than a century ago the proliferation of life-saving medications that are available today?
Almost as astonishing are the unintended perversions of their use.
The problem of drug addiction, a difficulty since the discovery of the pleasant effects of opium which dates back to circa 3400 BCE, has expanded into a panoply of pain-reducing pharmaceuticals that are beneficially used by the medical profession countless times every day. The diversion of such medications has reached epidemic proportions in our lifetimes.
In the postwar period, heroin use became widespread but it was thought, perhaps naively, to be confined to inner city gang activity. In the 1960’s psychedelic drugs made their appearance. In the medical school I attended, there was active research in the commercial development of lysergic acid, the precursor to LSD.
I vividly recall WSB, the premier Atlanta television station, having a live broadcast on a Sunday afternoon featuring the chairman of the pharmacology department cheerfully “dropping acid” into his mouth and an associate professor extolling the interesting behavior of his boss’s trip. It was thought that such drugs would be a great benefit in treatment psychotic patients. It wasn’t long before the truly horrifying effects that could accompany that hopeful idea became obvious.
Now we are faced with a crisis of potentially epic proportions with the diversion of ethical use of narcotics and related drugs to recreational use. Although accurate figures are difficult to substantiate the data would indicate that more than 44,000 deaths occur annually in this country from overdose of such drugs. How many of these deaths are intentionally suicidal and how many are accidental is even harder to know but the fact remains there are more drug-related deaths from these medications than from automobile accidents.
Little of this comes as breaking news; we hear and read about it every day. There are some hopeful signs. Systematic study of how this all came about is gaining momentum. Medical centers are developing programs that offer the possibility of interrupting the cycle of substance abuse before it has spun out of control.
There is no shortage of culpability. Some pharmaceutical companies have been reckless in shipping massive amounts of opioids to areas where addiction is running wild. The morning news recently reported a routine traffic stop in a Midwestern state that seized 110 pounds of fentanyl, enough to kill 26 million people, according to the DEA.
Physicians sometimes have not been as diligent in their dispensing habits as they need to be. The public has not been sufficiently informed of the risk of addiction in the use of narcotics. Pharmacies may have been lax in recognizing that patients may be using more than one source. Families, who have had a legitimate use for opioids may not be alert to the possibility that unused drugs can be pilfered by family members. The mechanisms for disposing of unused narcotics are cumbersome. The list goes on and the complexity of addressing these problems is substantial, but it can be done.
Carilion Clinic has established a multidisciplinary task force to approach the problem. This includes multiple data bases in which cross-referencing will not only identify abuses of prescription narcotics and other psychotherapeutic drugs but can send up a warning flag for those patients who are at high risk for inadvertent addiction. The net cast by such surveillance can become too broad making it difficult for the legitimate users to secure refills. Refinements to target the problem areas without complicating lives of the large majority who use these needed agents responsibly is daunting.
We did not arrive at this juncture recently thus it is unreasonable to think it will be quickly solved. Only by heightened awareness by all parties involved, including the patients, can we hope to stem the tide that, although decades old, seems to be approaching the flood stage. To ignore the severity of the problem puts us all at peril.
- Hayden Hollingsworth, MD
