Summary/Abstract

The government, the CDC and the WHO respond with a level of urgency and efficiency to a potential healthcare crisis that, at the moment, measured by mortality incidence is insignificant when compared to the mortality rate of addiction worldwide and it's blood borne counterpart diseases - HIV & Hepatitis C, is incomprehensible

Content

Gone to graveyards, everyone
Oh, when will they ever learn?

 

During the last 4 months of 2014, the media engaged the world's limbic system with a new bugaboo, the threat of an Ebola epidemic. This is fertile fodder for the media as there is no cure and no vaccine and therefore no story expiration date. America stood by mesmerized by the horror of a third world hemorrhagic fever coming to this country and wiping out tens of thousands of lives. This sensationalism reminiscent of the anthrax incidents following 911 generated a wave of irrational fear that rocked financial markets causing more collateral damage than the disease could itself.

But an epidemic has been raging for the past decade, claiming hundreds of thousands of lives directly and indirectly and yet we as a global community have made few inroads towards a solution.   This is not to say that the Drug War and the current opioid epidemic have not garnered significant media coverage over the past years, however if one discards the political hyperbole intended to pacify the masses and carefully examines the drug policy and funding priorities, the economic, healthcare and the societal ramifications remain relatively constant. Addiction and substance use disorder, whether it be treatment, incarceration or medication intervention is incredibly profitable.   Are we addicted to the Greek drama of addiction? Is there too much money at stake to move the cheese and reduce the profit margins? Are we so arrogant as a nation that we cannot learn from the lessons of history and the successes of other countries? The answer is regrettably, yes. As Thomas Jefferson once said, "Money, not morality, is the principle commerce of civilized nations". This drug war and the current epidemic have spawned a new economy where individual big Pharma players are generating more EBIT annually than the Mexican Spinola Cartel, treatment conglomerates are now traded publically, prisons are outsourced and a urinalysis can be billed for up to 1,500. The list of malfeasance goes on ad infinitum. Substance abuse disorder, unlike Ebola, has become a sustainable commodity and human life and suffering have become merely collateral damage. However, Ebola, for the moment, is a good distraction. When we develop the Ebola vaccine then we can chalk one up for the good guys. Hey wait, didn't Scripps develop a vaccine for Heroin that is now in Phase II testing?

I have always believed that most situations we perceive as insurmountable problems are in fact perceptual problems in which we have constructed a story, woven a myth to support our perception of the issue and ultimately gives us an out and that in most cases, a critical reexamination will yield different approaches and potential alternative beneficial solutions. I use the greatest good for the greatest number as my yardstick and understand that 80% is a reasonable goal. There are no magic bullets. And finally, I understand that there is not a conventional solution to every problem and therefore acceptance of such fact is the solution to said problem. I see the philosophical underpinnings of the drug war and the hyper vigilant response to the so called substance use disorder in this light.  I do believe that Albert Einstein was spot on when he stated “We can't solve problems by using the same kind of thinking we used when we created them”. We have been using the same thinking for over 50 years and the results are horrific. Our ideological crusade perhaps will be recorded in American history as the most ill conceived, illogical, destructive assault on the American citizenry since slavery.

I grew up during an era when body counts from the Vietnam War were routinely reported on the nightly news. Our government and military deployed troops and military resources based upon the size and threat of the enemy to prevent loss of life.  Tactically and strategically this makes sense.  Over the past several months, to witness the government, the CDC and the WHO respond with a level of urgency and efficiency to a potential healthcare crisis that, at the moment, measured by mortality incidence is insignificant when compared to the mortality rate of addiction worldwide and it's blood borne counterpart diseases - HIV & Hepatitis C, is incomprehensible. What is particularly disconcerting is that an addiction epidemic has been ravaging the United States for the last decade claiming 125,000 lives from opioid overdoses and globally between 350,000 - 500,000 lives from Hepatitis C and 1.5 million from HIV annually. Our prisons and jails house 25% of the world’s prison population of which 65% meet the diagnostic criteria of substance use disorder and another 20% for drug related crimes. To make matters worse, our current healthcare system accommodates only the middle and upper classes who have the financial means to access treatment. The addiction treatment industry has evolved into a 34 billion dollar industry with a very poor track record.  Economically incentivized Buddhas tout evidence based practices yet the industry has yet to adopt a universal lexicon and has yet to develop and implement aftercare care monitoring that would yield metrics on efficacy of treatment types.

Our inner city addicts, the majority black or Latino, are merely disposable lives that fill beds in outsourced prisons owned and managed by publicly traded companies. As society's throw aways, they serve as a financially attractive alternative to off shore labor. Inmates drive EPS. The more heads in beds the more revenue. Enter big Pharma, a capital offender, with an extensive menu of psychotropic medications that is too extensive to list. The drug-disorder life cycle appears to be create a drug, create a disorder, elevate the awareness of the alleged disorder and saturate the market with the pharmacological treatment for that disorder. When the market for the particular substance is saturated, it is then common practice either to expand or change the symptom sign constellation (revise the DSM) to enlarge the target market.

Over the past century since the Harrison Act was passed to generate additional Government tax revenue, our drug control legislation and law enforcement policies have created a multibillion dollar black market that has resulted in gang wars that have claimed over 135,000 lives in Mexico alone.  This is the epidemic. From an epidemiological standpoint, both addiction and substance use disorder are environmentally communicable. Current medical science has proven through empirical neurobiological research that not only is addiction a chronic brain disease but also often genetically predisposed. Recently, several prominent neuroscientists and addiction researchers have focused on the role of epigenetics as a causal factor in addiction and substance use disorder. Environmental stressors such as poverty, early childhood abuse, violence, education, inequality, hopelessness are correlated with neuroadaptations that predispose and reinforce addictive behaviors. A simple translation is the human beings are wired to avoid pain – fight/flight and we continue to rewire in reaction to our environmental stressors to mediate emotional, physiological and spiritual pain or dis-ease.   The presence and extent of external environmental stressors play a critical role in informed intervention, treatment and recovery. So, is it the chicken or is it the egg? One could hypothesize that much of what we define as causal factors for substance use disorder is a manifestation of a systemic societal problem rooted in generations of pseudo-Moralism and class and racial inequality which have been perpetuated by predatory economic interests that determine criminal justice and healthcare policy. To address and correct this problem is to admit our complicity in creating and maintaining a socially toxic environment that encourages substance use assuming that the etiology of substance use disorder follows a multifactorial pattern. Unfortunately current legislation and enforcement policies reinforce and exaggerate the incidence and prevalence of substance use disorder by creating hostile, discriminatory external environments both in pre and post treatment phases that discourage entry into treatment and create barriers for successful reintegration to society and long term recovery.

Why are we allowing people to die and who is accountable?

Syringe Exchange Programs                                                                                               In 2011, the government halted funding of syringe exchange programs that had been effective in reducing the transmission of two life threatening diseases - HIV and Hepatitis C which account for between 1.8 to 2 million deaths per year. Long term data from the CDC, WHO and multiple municipalities incontrovertibly demonstrate the efficacy of Syringe Exchange Programs in reducing incidence of Hepatitis C and HIV infection, reducing healthcare costs, increasing intravenous drug user admissions into formalized treatment, increasing public safety and reducing HIV and HCV related mortality. Why does our Government fail to support these programs?
 
Overdose Prevention
Since 1974, emergency rooms have administered Naloxone to reverse opioid overdoses. Thousands of lives have been saved. Yet, with the incontrovertible evidence of efficacy (97%), only 24 states have enacted legislation allowing either laypersons or emergency personnel to possess or administer this life saving. If the drug is safe and 97% effective in reversing overdoses. Why is it not readily available?

So my ire is directed at the government for what could by definition constitute wanton disregard and negligent manslaughter, the healthcare system for their inability to become politically engaged, the citizens of this country for their apathy, Corporate America for their greed and predatory behavior and finally, the addiction recovery community for not overcoming their shame and lending their 20 million plus voices publicly to end this genocide. Money, not morality, is the principle commerce of civilized nations.

Table 1:  Ebola - Hepatitis C - HIV

Access the risks - count the bodies