July 12, 2012
Drug Wars Abroad, Prescription Pain Killers at Home
Masked by our continuing drug war in Mexico, and the administration's recent expansion of U.S. drug enforcement into Central America and the Caribbean, is the more serious problem of prescription drug abuse, especially opioids, the class of psychoactive drugs used for pain management which includes codeine, hydrocodone, and oxycodone, among others. By all measures, the illicit consumption of prescription opioids today exceeds any of our previous drug crises, including heroin in the 1960s and 1970s, and crack cocaine in the 1980s and 1990s. Because those addicted to prescription opioids often take far in excess of safe doses or ingest them in a dangerous manner (chewing, smoking, injecting, or mixing with other drugs), rates of overdose also have exceeded anything we saw with heroin or cocaine. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), reports a 100 percent increase in emergency room visits associated with prescription drug misuse since 2007. After marijuana, prescription drugs comprise the majority of illicit drug abuse among 12th-graders in the United States, according to a National Institute on Drug Abuse (NIDA) study.
Eight percent of high school seniors reported non-medical use of Vicodin; 5 percent of Oxy-Contin. In a report released in April 2011, the Obama administration noted that "Prescription drug abuse is the Nation's fastest-growing drug problem," labeling the problem an "epidemic." The problem is not as simple as it seems, and certainly not as much as we would like it to be. NIDA broadly defines prescription drug abuse as "the intentional use of a medication without a prescription; in a way other than as prescribed; or for the experience or feeling it causes."
This, however, includes a broad range of users, including recreational and experimental users, but also people whose addiction began therapeutically in pain management. It also includes individuals who, lacking health care coverage, have borrowed or illicitly purchased medication for legitimate pain management. And then there are those who will develop a problem relationship with these drugs for some of the same reasons as people do with alcohol or illicit drugs: as a "self-prescribed" treatment for common mental health conditions such as anxiety or depression. Certainly, the absolute criminalization of illicit prescription drug use -- historically a favored but generally ineffective policy in the United States -- will be even less appropriate here. The solution should focus on production and distribution oversight and treatment interventions for those with addictions.