It came as quite a shock to me when reading recently that the FDA approved a new medication, Zohydro ER. This legal narcotic painkiller is a long-acting form of the analgesic hydrocodone. The short-acting version of this drug is more commonly known by its street names: Vicodin and Lortab. Why is this such a big deal? Because deaths from prescription painkillers like hydrocodone are on the rise. In fact, there has been a 300% increase in deaths since 1999, so much so that deaths from prescription painkillers now kill more people than heroin and cocaine combined, according to the Centers for Disease Control and Prevention (CDC). Furthermore, almost 75% of all prescription drug overdoses are caused by prescription painkillers. Essentially, what the FDA’s decision does is to legalize a more potent form of a drug (the available dose of 50 mg is nearly five times greater than current short-acting regimens) with a greater potential for addiction and adverse consequences (the pills can be easily crushed, snorted, or injected) in a country whose rates of use and abuse are skyrocketing. Legalizing a more intoxicating form of an already-dangerous drug does not sound harmless to me; it sounds like the FDA is making it easier for people to hurt themselves.
So what rationale did the FDA use? Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research, said, “To say people with chronic pain who are taking opiates around the clock that we shouldn’t offer them an extended-release option is unnecessarily penalizing the patient.”
I don’t think people with chronic pain issues need to suffer either, but that doesn’t mean giving them a medication that acts against their long-term health for the sake of short-term relief. Pain relief could result in placing everyone with severe, chronic low back pain in a medically induced coma, but that would not be in the patient’s best interests.
The issue behind this story is one that has evolved in recent years: prescription drug abuse stemming from addiction. In the case of hydrocodone, for example, faithful physicians may prescribe powerful medications like Vicodin in order to alleviate pain, but such medications have a very high potential to induce addiction or the body’s physiological dependence in order to function properly. Essentially, physicians attempt to treat pain at the risk of creating someone who subsequently becomes addicted to the pills. Generally speaking, dependence need not be limited to medication, and may include heroin, sugar, sex, or alcohol, for example.
Although addiction is very real, the problem nowadays is that once someone is labeled “an addict,” they invariably are victims of “a disease.” Once that bold step is made, responsibility shifts from the conscious, free-willed adult to the insurmountable malevolence of the addictive agent. To assume that either entity is totally responsible is a fallacy, but to dismiss completely that we all have a part to play in our own behavior is even worse.
To highlight this point from a biological standpoint, in July 2013, researchers at UCLA used electroencephalographs (EEGs, or apparatuses that detects or records brain waves) to evaluate whether people who were labeled “hypersexual” actually had some form of distinguishing, quantifiable abnormalities. The study was published in Socioaffective Neuroscience and Psychology. The result? The brains of the “hypersexuals” had no unique response to sexual images and therefore no distinguishing physiological response. The obvious deficit in this study is that it still does not explain why people behave this way, but would a similar study be able to accurately quantify self-discipline? Would temperance have its own unique brain wave pattern?
On one hand, one is tempted to believe that the hypersexuals are seriously plagued by the uncontrollable, persistent, and insatiable desire to fulfill their sexual desires to the detriment of their marriages, work, friends, and family because their behavior works totally against overall happiness and long-term self-interest. Such people obviously have no reasonable incentive to “fake it,” which means there must be something very real going on that is not apparent on standard EEGs.
On the other hand, that something real may just be a diminished sense of self-control or the heightened desire to fulfill their primal desires no matter what the cost.
My argument is not to point fingers at the individuals involved, but to realize that the addict-drug relationship is complex and dynamic involving human beings who each have their own unique genetic makeup and biological responses. I once took Percocet (like Vicodin) after a dental extraction. The pain certainly went away, but I felt so loopy and disoriented I would rather be in pain. John Q. Public may get a “high” from the same pill, and thus, his unique makeup will predispose him toward becoming addicted if he takes the medication for whatever initial reason.
Let us all not forget that the agents of addiction never force themselves on a person. The path to addiction begins with a free, voluntary choice by an individual. If we allow addiction to become totally and completely medicalized, then addicts becomes patients, and patients have a burdensome disease. To heal disease is part of what medicine does, but if that medicine ignores the contribution of the patient to their own disease then the battle is much more than uphill, not to mention dismissing the patient of any and all responsibility.
If addiction was a purely biological phenomenon, then it would have to pose some form of survival advantage, yielding more opportunities for reproduction. Unless you’re addicted to sex, no addiction increases your survival and by a host of secondary effects makes you less likely to survive and less likely to reproduce. Alcohol, for example, can lead to chronic liver disease and cirrhosis, both of which will cut your life span short.
Further, in my opinion, since a person can become addicted to anything (e.g., fame, body image, money, power, family, children, video games, and shopping), I have to assume that for each person, an experience indeed causes some kind of a positive physiological response that makes the person perceive happiness. Everyone wants to be happy, so they do the anything again to gain more happiness, and so the cycle goes on. Each person likely has particular predispositions to certain addictions (e.g., why alcoholism runs in families and is much more likely among twins), which is why the same addictive potential does not apply to all people equally. Hence, addicts are active participants in their addiction and are therein capable of changing behavior patterns based on their own initiative and the perceived costs and benefits. Physiology will play a role based on how much and how long the person has been addicted.
Finally, once we refrain from labeling addicts as “patients” with a “disease,” we free them from the idea that they must be treated either by a medical professional or some other external organization. It also eliminates the notion that complete and total abstinence is the only path to take in order to eliminate the “disease.” After all, no addiction has an objective way of biologically testing for it; they all rely on descriptive questionnaires or point grading systems.
I think the best path to take is to start treating everyone who is addicted as a free-willed adult and give them the respect they deserve as human beings, not passive bystanders in a cycle they have no control over. That’s when the healing can really begin.
Dr. C. H. E. Sadaphal