Our journal club, where we read the month's New England Journal of Medicine among a group of doctors from various specialties, now starts every article by examining not the names of the authors, or an examination of the universities from which they generated their studies, but a look at who sponsored the study--many if not most "investigators" are now funded by drug companies to assess the efficacy of the drug the company is trying to market. So if the drug is made by Merck, then Merck sponsors a group at Harvard to run a study to see if it works.
As Upton Sinclair said, "It is hard to bring a man to understanding if his salary depends on not understanding."
I now feel the same way when I read papers on the question of whether or not our approach, or our various approaches, to treating drug addiction are effective.
Even the web site of the National Institute of Health's National Institute of Drug Abuse reads like something between a marketing plan and a legal brief more than an dispassionate examination of data.
Money spent on drug rehab programs, the site tells us, is far less than it would cost to incarcerate drug addicts. We are also shown a bar graph which shows that during the time an addict is in the program, he stops using drugs, but he relapses almost as soon as he quits. The NIDA tells us, this is acceptable, if you think of drug abuse like hypertension; it never disappears. You have to continue treatment for life.
But the problem is: What is your goal?
If your goal is to get the drug fiend, as addicts call themselves, to stop using drugs forever, then what the NIDA is saying is, forget that. It's like alcoholism: You will always crave that fix.
But if your goal is to reduce the illnesses associated with drug abuse: HIV/AIDS, hepatitis and subacute bacterial endocarditis, then treatment programs, most particularly clean needles, do that effectively.
Whether drug rehab programs reduce drug overdose deaths is tough to say.
If you are running a program, and one of your clients overdoses and dies, do you say, well, we failed? Let's record that as a failure, and make your statistics look like you are a worthless organization running a failing program, or do you say, well, that guy dropped out of our program a week ago--his death is not on us.
The question is: What do we do? Just give up?
I would say we should do what Portugal did: Legalize drugs and treat addicts as a public health problem.
Of course, that's not easy in a for profit, commercial health care system like ours.
You really need a government health care program for that, because drug addicts are going to make every bottom line in every ledger look bad, from ER visits, to hospitalizations to deaths.
As Upton Sinclair said, "It is hard to bring a man to understanding if his salary depends on not understanding."
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| One Squirrely Slide--coming from the NIH! |
I now feel the same way when I read papers on the question of whether or not our approach, or our various approaches, to treating drug addiction are effective.
Even the web site of the National Institute of Health's National Institute of Drug Abuse reads like something between a marketing plan and a legal brief more than an dispassionate examination of data.
Money spent on drug rehab programs, the site tells us, is far less than it would cost to incarcerate drug addicts. We are also shown a bar graph which shows that during the time an addict is in the program, he stops using drugs, but he relapses almost as soon as he quits. The NIDA tells us, this is acceptable, if you think of drug abuse like hypertension; it never disappears. You have to continue treatment for life.
But the problem is: What is your goal?
If your goal is to get the drug fiend, as addicts call themselves, to stop using drugs forever, then what the NIDA is saying is, forget that. It's like alcoholism: You will always crave that fix.
 |
| click on image |
But if your goal is to reduce the illnesses associated with drug abuse: HIV/AIDS, hepatitis and subacute bacterial endocarditis, then treatment programs, most particularly clean needles, do that effectively.
 |
| click on image |
Whether drug rehab programs reduce drug overdose deaths is tough to say.
If you are running a program, and one of your clients overdoses and dies, do you say, well, we failed? Let's record that as a failure, and make your statistics look like you are a worthless organization running a failing program, or do you say, well, that guy dropped out of our program a week ago--his death is not on us.
The question is: What do we do? Just give up?
I would say we should do what Portugal did: Legalize drugs and treat addicts as a public health problem.
 |
| click on image |
Of course, that's not easy in a for profit, commercial health care system like ours.
You really need a government health care program for that, because drug addicts are going to make every bottom line in every ledger look bad, from ER visits, to hospitalizations to deaths.
Mad Dog,
ReplyDeleteAgree-Portugal's approach seems significantly more effective. Why don't we treat drug addiction as a health problem rather than a criminal one and see what happens. At least give it a try-the current plan sure isn't working..
Not to split hairs, but Portugal decriminalized drugs-I don't believe they legalized them. Heroin, cocaine etc are still illegal and are not being dispensed by any health care agency or the government, that is only being done with methadone. Dealing drugs is still illegal, but they are not arresting the users-or so I thought.
I also read the same piece from the NIH and like you, was skeptical when they equated drug addiction with diabetes and hypertension. Yes they are all chronic conditions and yet they don't seem like they all belong in the same basket..
By the way your photos-of Iceland I presume-are amazing. Very unique, otherworldly terrain..
Maud
Ms. Maud,
ReplyDeleteYes, you are correct. That is a distinction with a difference.
I don't know how they manage to arrest drug sellers while leaving the users unpunished. Are users not also selling on some occasions? Whatever it is they do, we ought to be listening to them.
Yes, those are Iceland. You really have to click on them to enlarge to get the real spooky feeling.
Mad Dog