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Opioid Woes, How We Mishandle Them & One Reform

John Dewar Gleissner is the author of the ebook, Get Tough & Smart: How to Start Winning the War on Drug Addiction.

Fentanyl pills

Fentanyl pills

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Opioid Woes, How We Mishandle Them & One Reform

We are losing or have already lost the old War on Drugs. American life expectancy has declined for three or four years in a row on account of increases in drug overdoses, chronic liver disease and suicide, all three linked to drugs and alcohol. To avoid reversal of the American Dream, we must change strategy and tactics.

Overdose survivors sometimes have permanent brain injury due to oxygen deficiency during overdoses. About 25% of those entering brain injury rehabilitation are there on account of drugs or alcohol. About 50 percent of people receiving treatment for substance abuse have a history of at least one brain injury. Skyrocketing drug overdoses over time produce even less intelligent and capable addicts. Toxic Brain Injury is the new term for this neurological damage.

We now know opioids were over-prescribed. The U.S. is now awash in fentanyl, a potent opioid some 50 to 100 times more powerful than morphine. Overdose deaths in the U.S. skyrocketed after imported fentanyl and its analogs made it to the streets from legal and illegal laboratories. Fentanyl is such a powerful opioid that 0.25 milligrams can kill you. Addicts have difficulty taking a safe amount.

We cannot seem to keep opioids out of the illegal market for addictive drugs. The number of Americans with opioid use disorder, otherwise known as opioid addiction, is around 3,000,000. The U.S. now has the most horrific opioid addiction problems in the world.

We enabled our way into this tragic situation. Some of the ways we enabled need reversal. One thing we do is repetitively administer naloxone to overdosed addicts, revive them, get them breathing healthily, take them to the emergency department of a hospital, begin detoxification, and then let them leave against medical advice so that they can meet their drug dealers and buy more opioid. Most of this is at public expense through Medicaid or Medicare. It is now no longer unusual for some of these Frequent Flyers to overdose a dozen or more times in a row and get on a first-name basis with emergency department staff. This revolving door causes emergency department physicians and nurses to suffer from burnout, compassion fatigue, and secondary trauma.

Right in the middle of the Opioid Crisis, with no quick solutions in sight, officials and academics recommended the increased use of naloxone, the drug which miraculously revives overdosed addicts. It saves the lives of addicts, and continues to rescue them from the consequences of their addictions … again and again and again. The number of nonfatal overdoses increased. But so did the number of fatal overdoses. In 2020, fatal overdoses shot up again to an all-time high of 93,000, 29% higher than in 2019. An important study showed that widespread use of naloxone increases the amount of drug abuse. Something that reduces the risk of opioid use increases the use of opioids. That is the definition of enabling, reducing the consequences of drug abuse.

The widespread use of naloxone, brand name Narcan®, in several ways makes our drug problems worse by encouraging risky behavior, increasing the number of overdose emergencies and enabling drug addiction. Medical treatment for overdoses enables more drug abuse even as it saves addict lives. In fact, constantly treating overdoses can even be characterized as aiding and abetting felonies. That is an absurd and inconsistent legal conclusion, even if technically correct, but it points out the need for reforms. There has to be a limit to the number of opioid overdoses paramedics, police, doctors, nurses, and hospitals provide to America’s drug addicts. Overdosing addicts need diversion into medication-assisted drug treatment, and we must make sure they stay compliant.

The brain disease paradigm presupposes that our duty to the individual is paramount. Accordingly, physicians and clinical psychologists believe their highest ethical duties are to help and treat the individual. American law, on the other hand, while according individual rights and liberties great deference, ultimately subordinates the well-being of the individual to the best interests of society. The individual ultimately yields to the law in the form of criminal and civil punishments, taxes, regulations, civic duties, military service, restrictions and other requirements and impositions.

If each State draws a statutory limit to the number of opioid overdose rescues provided in hospitals, more addicts will remain abstinent or compliant with their medication-assisted treatment. Such a limit would also correct the anomalies presented by the enabling of drug addicts. Addicts could continue the use of naloxone, but they would not be entitled to first-class medical and hospital treatment. Sound tough? We will have to do something other can continue enablement. We let the problem get way out of hand, and it is time to start tightening up.

John Dewar Gleissner is the author of the ebook, Get Tough & Smart: How to Start Winning the War on Drug Addiction.

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