In opioid fight, find balance of supply and demand reductions

In opioid fight, find balance of supply and demand reductions
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In June of 1971, President Richard Nixon declared a war on drugs in America. It was at the height of the Vietnam era that we saw a rise in the use of illicit drugs ranging from marijuana to heroin. President Nixon then signed into law The Comprehensive Drug Abuse Prevention and Control Act and established the Drug Enforcement Administration (DEA). Despite our best intentions, the drug casualties continued to mount and today, we face a new crisis — an epidemic of opioid use disorder.

As resources were allocated to fight the “war on drugs”, two schools of thought emerged regarding what should become the focus of the war. On one front, advocates for supply reduction felt that efforts should be directed toward reducing access to illicit drugs. Supply reduction refers to regulation and criminalization of the drugs themselves.

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This approach included efforts to control the transport, sale and distribution of the drugs, both within the country and from across foreign boarders. As supply reduction became the focus of our nation’s efforts during the 1980s, our nation’s prison system grew to unprecedented proportions.

 

Yet our people remained addicted. The National Council on Alcoholism and Drug Dependence, Inc. reports that 80 percent of Americans who are arrested abuse drugs and/or alcohol. Nearly 50 percent of jail and prison inmates are clinically addicted, and nearly 60 percent of individuals arrested test positive for illegal drugs at the time of their arrest.

While supply reduction has an important role to play, addiction remains a public health crisis in America. We must strike the right balance between supply reduction and the other “battlefront” — demand reduction.

We have learned an amazing amount about the neuro-science of addiction since we started the war on drugs almost 50 years ago. We now know that exposure of the brain to pleasure producing substances commonly results in irreversible changes to the individual’s pain and pleasure balance. Substances that release artificial amounts of dopamine in the brain’s emotional center may lead to lifelong compulsion to cope with life chemically.

Once these changes occur, the drug of dependence becomes an absolutely essential component to the individual’s contentment. This compels the person to go back and use the drug over and over again despite the harmful consequences. This is known as addiction, which is a chronic brain condition that may require lifelong treatment, and certainly requires lifelong vigilance. We must acknowledge addiction for what it is — a disease — one that can be prevented, and treated successfully when access to proper care is available.

Knowing this, the future approach to demand reduction will focus on education and prevention, early intervention and chronic, long-term treatment. Education for the public and healthcare providers regarding the risks associated with drugs, including legally prescribed opioids, have been shown to be highly effective. Early intervention is an effort to provide treatment before inappropriate drug use becomes a problem. Drug education and early intervention efforts in the past have proven to make a statistical difference in drug use.

For those with substance use disorder, we must think of the disease as other chronic conditions like diabetes or hypertension, which can be treated effectively with proper care. Long-term treatment for addiction can be successful and allow people to live stable and productive lives. Best results for treating addiction are achieved when we provide medication assisted therapy combined with behavioral counseling.

For those with the disease of addiction, incarceration and punishment does not serve as a deterrent, nor does it reduce the conditions of the disease. Treatment must be a central part of solving the problem.

In his book, "The Art of War," Sun Tzu speaks to this need of both types of intervention; “In battle, there are not more than two methods of attack: the direct and the indirect; yet these two, in combination, give rise to an endless series of maneuvers.”

As the war on drugs endures in the United States, we will continue to struggle over the appropriate allocation of resources and attention to both the direct battle of supply reduction and to the indirect battle of demand reduction. Finding the right balance will position us for the greatest chance of victory, but if the last 50 years has taught us anything, we’ve learned that as long as demand is strong, supply will always find a way.

Brent Boyett, D.M.D., D.O., is the founder and chief medical officer for Pathway Healthcare.