Why America Has a Prescription Drug Epidemic: To Regulate Or Educate? No Question -- You Do Both

Can 'big pharma' really be held to account for the prescription opioid problem anymore than let's say the alcohol industry can for alcoholism? I'm not sure, but it has got to be more than coincidence that both industries often to respond to such concerns by offering and actively supporting 'education' rather than regulation.
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The Global Drug Survey grew out of my interest in the use of drugs within the rave scene in the 1980s and 90s. Since that time GDS has evolved into the biggest annual survey of drug use in the world. While we retain a strong interest on the dance floor we have expanded our gaze to track new drugs trends, keeping an eye on substances that afford both pleasure and pain to people. Two years ago we started exploring the use of prescription medications such as sleeping tablets and pain-killers. Last year about one in four people who reported receiving a prescription opioid medication such as Oxycontin or tramadol reported that they had used such a medication to 'get high' in the last 12 months. These were not people with heroin or crack dependence that society tends to shun (or more commonly arrest and imprison) but instead were people who answered our survey - typically employed and educated. So while as a group they took more drugs than average, they were not a group who we were expecting to use opioid medications to get a buzz. And this group were not accessing their prescription medications from dealers but from doctors. And where were those doctors getting these high quality drugs from? The pharmaceutical industry, or as they are now called in most places 'big pharma'. Is it really possible that companies that produce life saving drugs and invest millions into research to cure society's ills could be behind the problem? Mmm yep.

Until the 19990s, opioids were used sparingly for chronic pain, in part due to historic fears that their long-term use was disguised maintenance treatment of opioid addiction, but also due to the concern that with longer term use, the development of tolerance would render them ineffective analgesics. But research, usually rather short-term research, showed that opioids could be used safely in chronic non-cancer pain. And they can. They bring relief from suffering to millions and in the decades that followed there was a rapid rise in opioid prescribing for chronic, non-cancer pain. This was driven more by pharmaceutical marketing rather than by clear evidence of efficacy and safety. The results have been well documented. As prescription of opioids increased for pain in the US, non-medical use of prescribed opioids rose in proportion. It's not that evidence of potential harm was missed; it was just not looked for that closely, with the research that was carried out rarely, if ever, having been conducted over long enough periods for the risks of addiction and misuse to arise. Overdose is a marker of the prevalence of opioid misuse, and in the years 1999-2006, fatal poisoning involving prescription opioids more than tripled. By 2002 opioid analgesics had overtaken heroin and cocaine as being the most frequently mentioned drugs in the Drug Abuse Warning Network (DAWN) system of notification of drug problems and by 2004 had surpassed heroin and cocaine as a cause of fatal overdose. More people die in the USA today from prescription medication than heroin!

So can 'big pharma' really be held to account for the prescription opioid problem anymore than let's say the alcohol industry can for alcoholism? I'm not sure, but it has got to be more than coincidence that both industries often to respond to such concerns by offering and actively supporting 'education' rather than regulation. The alcohol industry 'educates' drinkers about 'safe consumption' or 'responsible drinking'. In the USA 'big pharma' is responsible for more than 80% of medical education provided to doctors. 'Big pharma' also helpfully 'educates' the American public about their wares through vigorous direct to consumer marketing. Combine a quality product, excellent distribution networks, a stamp of medical approval, with national promotion and outlets on every corner and is it really any surprise that the US is now experiencing an epidemic of prescription opioid dependence and misuse. Heisenberg* would die for such promotion and networks(*if you have not watched Breaking Bad - then get it for Christmas).

So any solutions? Common sense is always one. Addiction is more than brain disease, no matter how much NIDA and brain scan images try and persuade us otherwise. To have a drug problem you first need drugs. And easier access = more use and more problems. So first regulate the pharmaceutical industry and ban direct to consumer advertising. Regulate doctors, education is not enough. Dispense with a system that actively promotes doctor shopping. Focus intensively on the tiny minority of 'pill mill' doctors who are responsible for a disproportionate amount of opioid analgesic prescribing. Education, supervision, regulation and prosecution take your pick. Improve access to free quality drug treatment services and improve translating the world class research that America does into on the ground help for those with drug use problems regardless of insurance status (treating drug dependence, improves lives, saves lives and make sound economic sense, in fact it's a bargain). And stop focusing on arresting and criminalizing people who want to get stoned on cannabis at the weekends or take an ecstasy pill at a club. These drugs are not killing the children of America. Prescription drugs are. Addressing the other drivers for addiction such as poverty, abuse, stigma, emotional and social deprivation, trans-generational disadvantage and inequality might help as well (it would help loads OK) but lets start with the easy things first eh? If you want to add your voice to the world's biggest drug survey, tell us honestly how easy it would be for you to get a script to get you high or whether your doctor ever mentioned the risks of your script or just want to contribute to the world's most important debate then join over 78,000 others from around the world here.

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