Claudewell S. Thomas, MD, MPH, DLFAPA, is an established psychiatrist currently retired and living in Rancho Palos Verdes, California. He received his medical degree in 1956 at SUNY Downstate College of Medicine and specializes in social psychiatry, public health psychiatry, and forensic psychiatry. Dr. Thomas was board... more
I don't know whether or not the POTUS has gotten around to declaring the opioid epidemic a national crisis. It seems that he has been busy with declarations that have added to national angst from the threat of launching “fire and fury” to declarations perceived as endorsing right-wing hate groups. His initial reaction was a revisiting of “Just say no” from the Reagan era.
The opioid crisis has been around and growing for a long time. It is a Public Health problem deeply entangled with illegal drug peddling, human trafficking, immigration problems, conflicting law enforcement standards, and dictates varying from the Federal level to state to state inconsistencies. Using a Public Health perspective, we can see it as existing on at least three levels. The easiest to wrap one's fingers around is the strictly medical usage problem where the opioids are over-prescribed to populations legitimately suffering painful disability and debility. The elderly are obvious members of this group and at particular risk of dying because of the accommodation to the drugs requiring more and more drug to suppress pain and the ease of surpassing the medullary level of sustaining of breathing and heartbeat.
Children also qualify as particularly susceptible but pediatricians are generally sensitive to the vulnerability of children and particularly cautious. The pain of the elderly is quite often intractable and related to aging processes and diseases like arthritis, diabetes, cancer etc. In the face of depression and the clock-running-down phenomenon, physicians often disregard the possibility of addiction developing.
Level two of the problem consists of those who in an effort to escape depression or to experience elation use a progression of drugs often starting with the relatively available metamphetamine, on through drugs like the barbiturates and opioids (fentanyl,hydrocodenone,codeine,morphine,demerol,etc). Such use, despite the underlying malaise, is loosely called recreational and is linked to distribution networks from dishonest physician sponsored fake clinics, through mob linked distribution through gangs, international cartels, trapping people through drugs and enslaving them through indebtedness. This level is superficially a law enforcement level and treatment and rehabilitation are important as a part of that effort. A combination which we are very bad at.
The third level is an experimental level preceding the clear cut recreational use by adults. It is occupied by preadolescents and teenagers. Often, accessing parental drugs is the beginning of it some of which is occasioned by malaise but much of it just curiosity and idle hands syndrome.
I suggest that some of the problem can be addressed (not solved) by utilizing the current cannabis craze and the concurrent creation of marijuana millionaires by more widespread use of cannabis for the relief of pain and malaise, particularly among the elderly. Some of the relief of pain appears to be the effect of cannabinol's anti-inflammatory effect throughout the body in the absence of the psychoactive component. But with the elderly, the psychoactive component with its accompanying mood elevation may be quite useful.
Such a programmatic effort would have to be on the state and local level not on the federal level because of the persisting federal classification of the drug. Those who would destroy dentition with metamphetamine and neurons with opioids and alcohol may have already bypassed marijuana on the road to perdition but ingenuity and mixed treatment modalities may turn them around. Its identification as a gateway drug (despite the sociological implication of gateway) would seem to interdict its use with adolescents, even with legal permission.
Those who are more knowledgeable about brain chemistry and current knowledge of agonists and antagonists as well as the vicissitudes of legal systems are more than welcome to comment and to tear apart my notions.