Illicit drug use and the debate surrounding the various legal options available to the government in an effort to curtail it is nothing new to America. Since the enactment of the Harrison Narcotic Act in 1914 (Erowid) the public has struggled with how to effectively deal with this phenomena, from catching individual users to deciding what to do with those who are convicted (DEA). Complicating the issue further is the ever-expanding list of substances available for abuse.
Some are concocted in basements or bathtubs by drug addicts themselves, some in the labs of multinational pharmaceutical companies, and still others are just old compounds waiting for society to discover them. Almost overnight one such venerable substance (or class of substances) has been catapulted into the national spotlight: prescription painkillers, namely those derived from the opium poppy. This class of analgesic encompasses everything from the codeine in prescription cough syrup to the morphine used in the management of sever pain.
These compounds are commonly referred to as opiates and are produced naturally by the poppy. The sub-class of this type that has gotten all of the attention recently is the opioids, which are semi-synthetic compounds derived from the opiates (Wade 846). Opioids were developed for a variety of reasons, such as reducing the cost of production (morphine is expensive to synthesize) and attempting to reduce the addictiveness of the drugs. And addictive they are. Heroin is perhaps the best-known opioid around, and arguably one of the most addictive substances known to man.
Opiates and opioids (hereafter generically referred to as opioids) function by attaching to receptor sites in the body called mu-receptors, which are primarily located in the brain and the digestive system. When these receptors are activated in the brain they produce a rush of euphoria and a groggy state of well being (it is interesting to note that studies have shown that this action does not eliminate the pain one is feeling, but merely changes ones perception of it) (Kalb).
The body quickly becomes tolerant of this, however, and abuse frequently follows a steep dosage curve requiring that more and more of the drug be taken to produce the same effect. Long-term abusers develop physical dependence that can lead to fatal withdrawal symptoms if the user is forced suddenly to stop. Part of the drugs attraction is that the general public considers them safe because they come from a doctor. It is easy to mistrust the shady street dealer selling pills on the corner, but the impulse to implicitly trust that which comes from the medical establishment is a mentality that is ingrained in us at a very young age.
The truth of the matter is that some of these drugs pack almost an equal punch as their street-level cousins. Take oxycodone for example. It is routinely administered in the form of a time-released pill (trade name OxyContin) meant to be taken once per day to treat the penetrating pain of cancer and other such ailments. If the time-release coating is removed and the compound is intravenously injected, it produces a rush that many experienced addicts find difficult to distinguish from that of morphine. And just like morphine and heroin, an overdose can lead to fatal respiratory depression (Kalb).
Aside from the physiological implications of abuse, the fact that abuse is so demographically widespread is cause for concern. No long is it only the traditional middle-class housewives and medical personal getting hooked, it’s former U. S Presidential candidate Paul McCains wife Cindy McCain and football great Bret Favre. Vicodin is quickly reaching parity with cocaine and ecstasy in the club scene all over the country. Emergency room visits involving the most commonly abused opioids, hydrocodone (Vicodin, etc. ) and oxycodone (Percodan, OxyContin), have more than doubled since 1992.
The number of people over twelve who reported using prescription pain medication recreationally for the first time tripled from 1990 to 1998. The Department of Drug Enforcement is saying an epidemic is imminent if nothing is done (DEA, Erowid). As with any mind-altering substance, different people will give different reasons for their illicit habit. A common precursor to opioid addiction is injury. An individual with a broken bone, strained tendon or toothache will request some form of relief from his or her physician, who will prescribe one of the above narcotics.
Often the patient during this time will begin to develop a tolerance for the recommended dose and increase it just a bit. This increased tolerance does not necessarily signify addiction, but it usually the first step. After the physician discontinues the patient on the medication and the patient exhibits withdrawal symptoms (tremors, irritability, nausea), it can be said that he/she is addicted. Often the habit starts by such innocuous means and explodes into something beyond control (Rosenberg). Opioid abusers will engage in drug-seeking behavior just as determined and sometimes mind-boggling as users of more traditional narcotics.
Often, raiding the medicine cabinet of an acquaintance is all that it takes to secure a fix. Many report the offhandedness some doctors prescribe these powerful drugs makes finding them nothing more complicated than a doctors visit. Some take this one step further, employing a tactic called doctor shopping, which is obtaining multiple prescriptions from multiple doctors for medication. Still others have the moxie to steal their doctors prescription pad and forge a prescription, or call one into a pharmacy using his narcotic control number (Kalb).
One disturbingly easy way to secure these drugs, which I discovered while doing the research for this paper, is over the Internet. Pharmacies from nearly every country on earth are represented there, and a few are more than happy to ship a controlled substance to a U. S. address. I found numerous web sites advertising codeine, hydrocodone, and an opioid-like medication called tramadol, all for fairly reasonable prices, and with no real worry to the purchaser except for the remote possibility that customs officials will confiscate the drugs (Erowid).
Recently this sort of low-key behavior has developed into full-blown violent pursuit. Pharmacies in some cities on the east coast will no longer stock narcotics to avoid the drug robberies that have dotted the area (Richwine). Oxycodone is sometimes called the poor mans heroin. Even with this undistinguished disclaimer, supporting a healthy habit is anything but cheap. The DEA has reported the average street price to be roughly one dollar per milligram. It is most often encountered in the OxyContin extended release tablet, which contains between 40 and 120 milligrams.
An active user with a high tolerance could go through one tablet a day, putting this habit in terms of cost right up there with the more traditional hard drugs. Many users report engaging in property and drug crimes to help feed their addiction, and data taken from cities with a higher-than-average use seem to collaborate this (DEA, Erowid). Abusing opioids is a criminal act in the United States, carrying fairly harsh penalties upon conviction. Why would one chose to ignore the social, fiscal, and physical side effects of abuse for the momentary high? The answer is about as complex and amorphous as they come.
Traditional criminological theories do a very good job explaining criminal events between different people. Most do not do a very good job explaining the motivations for drug abuse. The traditional ideas of offender and victim do not apply in this setting. The act is seen by some as a rational choice by an individual to do something that affects only himself; the crime is victimless. Others (namely the government) view the addictiveness of the drug and the burden the addict places on the community as evidence that society itself is the victim, and thus society is justified in prohibiting it.
Because of this inherent awkwardness, the only theory that is broad enough to rationally explain it is Hirsch and Gottfredsons General Theory of crime. It is able to accomplish this by moving the focus from the actors to the actions themselves. It does not try to explain specific rational for wanting to chemically alter ones perception, but instead notes the commonalities that all crimes contain: they provide instant gratification, they are risky, the benefits are short lived, the actions are easy to execute, and result in some undesirable outcome for the victim.
People who show a propensity for these things have low self-control, and this is the cornerstone of the theory. Hirsch and Gottfredsons work is often criticized for being overly broad, but it is the most intuitive model available for explaining this type of offence (Sacco and Kennedy). I believe the foundation of an effective prevention strategy lies in education, first and foremost. The government needs to get the word out about the physical and psychological dangers of improperly using these powerful analgesics, since most people view them as being safe.
A forceful media campaign like the old ones they did for crack and cocaine would do much for raising public awareness. Incorporating information about these substances into the DARE program which, at the time I was involved in it 6 or 7 years ago barely gave opioids a nod, would also be tremendously helpful. The DARE program is the first formal education children receive on substance abuse, and we need to properly educate them on all of the potential drugs out there.
Physicians should also play an active role in any prevention strategy; they are literally the first line of defense against those who would abuse the system to support their habit. Modernizing the system for prescribing narcotics would be an excellent step in this area. Utilizing new technology to make the prescription process a more secure transaction would have a large impact on the supply side of the issue since almost all opioids found on the street have in all likelihood been fraudulently redirected from legitimate sources.
If you close those loopholes that allow this redirection (forgers, social-engineering pharmacists) the supply would be drastically reduced. They should not in any way, however, be dissuaded from prescribing medication to a patient in genuine need. Pain is not something that can be measured, and no patient should suffer because a specific segment of the population cannot handle it responsibly. The key word here is vigilance on the part of the doctor, not radical departure from quality care.
The pharmaceutical companies themselves need to play a large role in this strategy to alleviate the pressure on doctors caught in the conflict between good medicines and supporting a drug habit. They should continue to devote research and development dollars to the study and synthesis of compounds that are comparative to the opioids in analgesic action but lack the euphoria and addiction potential of the morphine-derived medication currently available.
Ill be the first one to admit this is easier said than done, being that scientists have been working on this since at least the turn of the century when they developed heroin in an effort to curtail morphine addiction (? ) The truth of the matter is morphine and its relatives are simply the best treatment we have for pain management until science comes up with something better. Until that happens, however, pharmaceutical companies should be obligated to modify their existing product to prevent the misuse we are seeing today.
This would be particularly useful for the time-released version of oxycodone, OxyContin. Abusers looking for the heroin-like rush of euphoria either suck the coating off the pills or grind them up and eat or snort. Safeguards could easily be implemented to make this type of entry into the body uncomfortable or unfeasible. They could take lessons from the manufacturers of ephedrine-containing products such as Sudafed which for years were routinely tampered with by clandestine chemists manufacturing methamphetamine.
Today, it is considerably more difficult to extract the ephedrine from the pill due to countermeasures developed by the manufacturer, such as including microcellulose fibers in the tablet to gunk up the equipment used in the extraction. The idea could easily be applied to OxyContin tablets that would render them resistant to tampering. Additives could also be introduced that would give the tablet a horribly unpleasant flavor if ingested without the special coating, or would cause debilitating discomfort to the nasal passage if inhaled.
These are but a handful of cheap and relatively simple ways to address the issue of abuse until science gives us an equivalent, non-addicting alternative. The criminal justice would have to play a more pro-active role in my anti-drug strategy. First and foremost, I would make significant changes to or eliminate the Federal Controlled Substance Schedule, which is essentially a ranking system for illegal drugs that the government uses as a guideline when sentencing drug offenders. At the top are Schedule I substances, which are the most rigorously controlled.
LSD, heroin and ecstasy all reside at the top of this rather nonsensical hierarchy. Most prescription opioids fall under Schedule II, along with cocaine and amphetamine. Steroids, marijuana, and Valium are all listed at Schedule III or below, and have a lower priority to the criminal justice system. Incarcerating people with the clinically recognized disease of drug addiction is bad for society. Modifying and changing the Schedule from a sentencing tool to a treatment and rehabilitation guide would be absolutely essential to my comprehensive opioid abuse control strategy.
I would propose created just two tiers, one for drugs that probably require rehabilitation (opioids included), and one for those that realistically do not. We will call them Schedule A and B, respectively. For those who are convicted of possessing a Schedule A narcotic, a doctor would recommend to the court whether rehab would be necessary or not. If one were found to be addicted to opioids by this medical examination, they would be forcefully remanded to a clinic specializing in this type of treatment. Those found not to be addicts and those convicted of a Schedule B possession offence would be fined.
In the case of opioid abuse, treatment is a viable and preferable option to long-term imprisonment. It is not as straightforward as simply discontinuing use. As I mentioned before, the narcotic withdrawal experienced by a heavy user can prove fatal. Some sort of drug maintenance is needed so the addict can safely wean himself from the opioid. Since giving the addict more of his drug on the states dime is not a realistic option, science has developed a drug called methadone to facilitate this process. Methadone binds to the same mu-receptors as the other opioids, but it does not produce the euphoria (at least when taken orally).
With proper care, supervision, and counseling provided at my hypothetical state-run clinic, the addicts body will readjust to functioning without any foreign chemicals and he/she will hopefully be able to reintegrate into society. Methadone maintenance is not perfect. A sizable percentage will end up relapsing at some point in their lives and may need to come back for treatment. It is superior to our current lock ’em up mentality in many ways, however. It is less expensive to keep a person in treatment for a year than to keep them in a penitentiary.
Some clinics could cut costs even further by becoming outpatient only, since the risk of relapse while on methadone is very small. It is more a more dignified and respectful way to care for a member of society who is ill. Finally, it is in societies best interest to attempt to rehabilitate and keep individuals active in some capacity in the lives of their families and/or children in order to help he or she finally slay the demon of addiction (Erowidk, Kalb, Rosenberg, DEA). An easy solution to the problem of drug abuse of all types will continue to elude us, probably indefinitely.
Indeed, the problem can seem so overwhelming that people simply give up on a real cure and satisfy themselves with treating some of the symptoms, like banning certain medicines or locking up repeat users to keep them from indulging their habit. The truth of the matter is no one change or modification to existing policy will have much effect if any, on the current state of affairs. It isnt enough to ban drugs, we must work to understand their allure and the intricate mechanisms in our brains and in our psychology that make some of us too weak to resist the temptation. Only with this sort of concentrated effort will we see any progress.