By Lorie A. Parch
We can all pretty much agree that drug addiction, of any kind, is a tragedy. Illicit drug use (not including alcohol) costs the U.S. healthcare system on the order of $193 billion annually, says the National Institute on Drug Abuse, and deaths from “drug poisoning” have skyrocketed in the past decade, in large part the result of misuse of opioid pain relievers, but also from other drugs, like heroin (another opiate) and cocaine.
Many of us, though, might stop short of thinking of addiction as a chronic condition, almost exactly like diabetes or hypertension. Even fewer of us are likely to use the words “chronic disease” in describing opioid dependence (OD), the addiction to opiates like heroin and prescription painkillers like Oxycodone and Vicodin.
But OD is a chronic condition.
A recently released survey of 1,002 American adults and 200 doctors finds that myths about OD abound, both among the general public and physicians. The poll, which was conducted online by Harris Interactive on behalf ofpharmaceutical company Reckitt Benckiser (who make the drug Buprenorphine, which is used to treat OD) and released in June, had a number of surprises. “First of all, the survey found that the public and physicians have a lot of misperceptions and stereotypes about OD that definitely impacts the disease and the way those who are living with it are treated,” says Mark L. Kraus, M.D., FASAM, an assistant clinical professor of medicine at Yale University School of Medicine and a fellow of the American Society of Addiction Medicine (ASAM), who was affiliated with the survey.
“Ninety percent of physicians recognize that [OD] is a disease; the public feels less so. Most of the public and physicians feel it represents more of a mental health issue, a lifestyle choice. So the big problem there is that it’s recognized not as a physical illness, or a chronic disease, which we know it is.” Dr. Kraus says plainly that addiction is, in no uncertain terms, a chronic neurophysiological disorder. Yet most of us don’t think of it that way and too often we don’t treat OD that way.
Doctors and the public answering the survey were also more likely to think that becoming addicted to opioids was something that happened mostly to people of low income and little education. Not so. “They didn’t recognize that it’s an equal opportunity disease, like diabetes and heart disease,” says Dr. Kraus. “It doesn’t matter when it comes to gender, race, or socioeconomic status.”
Similarly, it’s easy to think about heroin use as something that happens primarily to those of a lower class, but people who become dependent on opiates very often end up using this hard-core drug, eventually. “What happens is that people use prescription pain medications that they get from friends and family and then that source dries up and they need to turn to people selling [the pills] on the street,” Dr. Kraus explains. “That becomes too expensive and they need to turn to heroin,” which is cheaper and works on the brain in exactly the same was as prescription opioid painkillers do, so they get the same high. This, says Dr. Kraus, is a particularly big problem among those 18 to 25; this group are, in fact, the biggest abusers of prescription opioid pain relievers, reports the National Institute on Drug Abuse.
One of the most surprising findings of the survey was how many doctors said that although they think OD is treatable, they saw relapse as inevitable. This, says Dr. Kraus, is part of the fundamental problem of understanding addiction as a chronic disease, not something to be “cured.” “Just like any chronic disease, there is remission and exacerbation. So there’s remission, where people achieve sobriety, and there are exacerbations, where people relapse,” he says, adding that rates of relapse in addiction aren’t very different from those of other chronic diseases, though precise relapse rates aren’t known. He thinks it seems like addicts relapse more often since we hear all the time about celebrities moving through the revolving door of rehab.
Dr. Kraus says that the way to treat OD should mirror that of treating, say, diabetes: first, you need to get the diabetic to understand that they have a disease, then you administer cognitive behavioral therapy that takes people through the “five stages of change” (a model that helps people make lasting change in their lives). Dr. Kraus says there are also medications that help, like methadone, and lifestyle changes, spirituality, counseling can all be part of a successful addiction management plan, too. A stay in a facility may be needed — or it may not. Depending on the initial evaluation, someone with OD may be checked into a hospital or other facility, or they may be treated at a nearby clinic as an outpatient.
If you think you might be addicted to opioids, or you know someone who is, it’s important to find a physician who understands addiction. “Your primary care doctor should be involved [too],” notes Dr. Kraus. “They can send you to someone who can help, a board-certified doctor that practices addiction medicine.” You can find an addiction specialist at http://www.turntohelp.com(which is run by Reckitt Benckiser) or you can go to the ASAM website.
Have you experienced OD or do you know someone who has?