Essay: The Genuine Drug War is in Biomedicine

Knowledge, not firepower, is the key to the future.

In modern American society, heart disease, cancer, HIV\AIDS, diabetes, alcoholism, and cigarette addiction account for millions of deaths. They are all disease entities with strong psychological and behavioral components—complicated, multicellular, multi-organ disorders. But they have all been associated, at one time or another, with negative personality traits and moral flaws. The less we know about the mechanics of a human disorder, the more likely we are to view its external symptoms as signs of laziness, or neuralgia of the spirit, or as a form of damage caused by specific kinds of thoughts and emotions. Without a doubt, all kinds of flaws are sometimes expressed in the behavior of people who have these disorders. Yet none of these flaws can be considered the root cause of the diseases.

Addiction is being added to the roster of physical disorders once thought to be symptoms of insanity, but which are now seen to be disease entities with strong mental components, like most diseases. As Professor Felton J. Earls of the Harvard School of Public Health argued almost twenty years ago: “Until we have an Institute of Addictive Behaviors, we are not going to get very far on the public-policy issues because we will not have our science-policy issues properly aggregated and organized in order to move forward on the issues in any meaningful way.”  Witness the tangle over merging NIDA and the NIAAA, and you’ll have a good idea of how far we still have to go in this respect.

The genuine drug war is being fought in the arena of biomedicine. The New York State Division of Substance Abuse Services in Albany  estimated several years ago that the annual bill for successfully treating a single drug addict is $3,850, compared with $14,000 in estimated annual expenses— health, welfare and law enforcement costs—associated with one untreated addict. The real crisis is the indisputable fact that there exists today an appalling shortage of funds for biomedical research—ironically one of the fields of scientific endeavor in which the U.S. holds a clear lead.

The cause of the dilemma is a fundamental misunderstanding among politicians and the public about how diseases can be understood and conquered. Cross-fertilization among scientific disciplines yields unexpected results. Targeted research, such as the much-ballyhooed war on cancer, or the crash program to find a cure for A.I.D.S., is not necessarily the most desirable way to proceed. Insights come from unexpected places, in serendipitous ways. As the scientific understanding of cells and receptors deepens, diseases and disorders once thought to have unrelated causes are seen to have common and entirely unanticipated origins. Research into the viral mechanisms of the common cold may ultimately yield more insights into AIDS then all of the directed research now underway. In biomedicine, there is no guarantee that goals can be reached through the front door, by a systematic assault akin to an engineering project. We cannot, for example, hope to cure addiction, or even the common cold, by means of the same methods we used to put a man on the moon.

There are, however, certain things we can begin to do immediately, if, as a nation, we are serious about drug abuse. As a society, Americans have not done a very good job of laying the groundwork for an objective look at addiction and recovery. To begin with, we must attend to the staggering number of drug-related deaths, injuries, and hospitalizations caused by the abuse of prescription medications. The government itself has proven the case for this contention in numerous reports issued by the National Institute on Drug Abuse and other official bodies. According to the U.S. Department of Health and Human Services, “Older Americans account for more than half of all deaths from drug reactions,” leading one to suspect that the majority of drug fatalities stem from accidentally fatal overdoses by heavily medicated senior citizens. Our national fixation on illegal drugs has blinded us to certain verifiable facts about prescription drug abuse.

We also need to recognize the problem of underprescribing opiates and other addictive painkillers for children and adults in hospital settings. If we continue to stringently prohibit the use and sale of synthetic and designer drugs like methadone, morphine, amphetamines, and barbiturates, we will have to make one important exception: pain abatement in medical applications. One of the great scandals to come out of the drug war is the growing understanding that potent painkillers are not being offered in sufficient amounts to patients suffering intractable and agonizing pain.

“There’s a certain amount of hysteria about narcotics among doctors,” maintains one researcher. At least half of all cancer patients seen in routine practice report inadequate pain relief, according to the American College of Physicians. For cancer patients in pain, adequate relief is quite literally a flip of the coin.

At least 6 million cancer and AIDS patients currently receive no appropriate pain treatment of any kind. In addition, WHO estimates that four out of five patients dying of cancer are also suffering severe pain. The numbers of untreated patients suffering intractable, unrelieved pain from nerve damage, burns, gunshots, sickle cell anemia, and a host of other medical conditions can only be guessed at.

Figures gathered by a different U.N. agency, the International Narcotics Control Board, make clear that “citizens of rich nations suffer less.” To put it starkly, the use of morphine per person in the United States is 17,000 times higher than per person usage in Sierra Leone. Doctors in Africa paint a grim picture of patients hanging themselves or throwing themselves in front of trucks as an alternative to life without pain relief. The U.S., Canada, Britain, France, Germany, and Australia together account for roughly 80 per cent of the world’s medicinal morphine use. Other countries, particularly the poor and undeveloped nations, scramble for what’s left.

In many cases, pain relief is the one thing doctors can offer their patients, and the one thing they withhold.

--Adapted from The Chemical Carousel, by Dirk Hanson

Photo Credit: http://www.eurac.edu 

Exercise, Attention, Meditation

Drug treatment alternatives.

A prescription for aerobic exercise might seem trivial in the face of the life-or-death battle people wage against rampant addiction. But with or without anti-craving drugs, both diet and exercise—two non-pharmaceutical methods of altering neurotransmission—will have roles to play in recovery.

Exercise, attention to diet, and nutritional supplements are only three of the complementary avenues being explored as components of addiction treatment. Successes have been claimed for acupuncture as well.  The same can be said for hypnosis. It has its vociferous claimants, but it has not been widely tested and documented as an addiction therapy.

Meditation, in its many Eastern and Western derivations, is used by some recovering addicts as a means of dampening the panic and anxiety that often accompany detoxification. And again, there is a certain amount of good science behind the notion. Sources as disparate as Maharishi Mahesh Yogi and Harvard’s Dr. Herbert Benson have produced evidence that sitting meditation—in which the mind is either purposefully made blank, or else is focused on a mantra (the Maharishi’s mantras are Sanskrit, but Dr. Benson maintains that any soft-sounding set of syllables will do)—produces verifiable changes in blood pressure, heart rate, and oxygen exchange. Years ago, Dr. Benson named this phenomenon the “relaxation response.” Many addiction clinics use variations on this theme in an attempt to ease withdrawal symptoms.

All of these alternative modalities suffer from the same limitations: a lack of large scale clinical testing due to inadequate funding, and a lack of adequate insurance reimbursements. Nonetheless, almost anything goes in the sprawling treatment and recovery industry. There are, for example, numerous clinics and treatment centers based on the principles of naturopathic and homeopathic medicine. The 3HO SuperHealth program that bloomed in Tucson, Arizona, a “holistic substance abuse facility” inspired by the teachings of the Hindu Guru Yogi Bhajan, was accepted by Blue Cross/Blue Shield and other major insurance providers. (Gaining insurance accreditation is a major factor in the success or failure of many treatment providers and large-scale programs.) There are drug recovery programs based on the spiritual wisdom of American Indians, on the teachings of the German mystic Rudolf Steiner, on assorted holistic health practices such as yoga, guided imagery, lucid dreaming, biofeedback, massage, and other forms of “personal growth” work.

Alternative therapists maintain that recovery from addiction is as much a spiritual voyage of discovery as it is a path back to conventional health and sanity. Traditional psychotherapy in isolation is a frequently ineffective method of treatment, while anti-craving pills, congeners, and replacement therapies are still quite new.

 Any treatment that claims to work for all addicts all of the time, under all conditions, should be viewed with extreme skepticism. It is safe to say that any commercial treatment program advertising success rates of 50 per cent or more is very probably engaging in short-term follow-ups, and may be seriously misleading the buying public.

Photo Credit: http://steveroni.blogspot.com/

Acupuncture for Addiction: It Doesn't Look Good

Needles fail in latest study of opiate detox.

Acupuncture as a treatment for drug addiction took another punch recently in a study published in the Journal of Substance Abuse Treatment. In “Auricular acupuncture as an adjunct to opiate detoxification treatment,” the study authors investigated whether acupuncture would “add value” to a standard methadone-based detoxification process. For the two-week study, 82 opiate-addicted patients were randomly assigned to either ear acupuncture by qualified acupuncturists, or the attachment of ear clips by non-professionals. Each day, the study participants were tested for withdrawal severity and craving.

"On none of the 14 days,” the authors report, “were there statistically significant differences between patients allocated to ‘real’ acupuncture and the ‘sham’ treatment. Such statistically insignificant difference as there were favored the ‘sham’ treatment....”

The results, say the authors, “are consistent with the findings of other studies which failed to find any effect of acupuncture in the treatment of drug dependence.” Moreover, the authors conclude, this finding is “particularly disappointing as if anything the circumstances favored the acupuncture option,” since in contrast “the alternative may not have been seen as a convincing therapy.” Nevertheless, “like the featured study, previous studies of acupuncture in the treatment of opiate addiction have been unconvincing.... The ‘ineffective’ verdict on acupuncture extends to the treatment of cocaine dependence,” the authors maintain, while an attempt to replicate earlier positive findings on acupuncture for alcohol dependence found no benefits, either.

The authors also reflect on whether such offerings, though of dubious value, attract addicts to treatment centers. “The possibility remains that offering something concrete like acupuncture helps attract people to services, and that doing something both clients and staff believe is worthwhile (even if it is a ‘sham’ procedure) helps retain patients in treatment, and in doing so improves outcomes.”

Of course, this is only one study out of many, and acupuncture enthusiasts remain as optimistic as ever. Proponents of acupuncture treatment continue to petition the National Institute on Drug Abuse (NIDA) for endorsement. Most reports of success remain anecdotal. Nonetheless, the National Acupuncture Detoxification Association estimates that there are currently 200 acupuncture detoxification programs operating in the United States and Europe.


Photo Credit: The 217

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