Uncle Sam wants your drugs! This Saturday the Drug Enforcement Agency (DEA) is sponsoring a nationwide prescription drug “take-back,” at 4,000 locations around the country.
Seeking to address the fact that in 17 states prescription drug combination overdoses kill more people than traffic accidents, and that prescription drug related treatment admissions have recently increased 400%, the DEA will collect your unused medications, no questions asked.
Taking a page from programs that allow people to turn in handguns without penalty, the DEA wants to see if the same tactic will work to reduce the supply of illicit prescription medication on the street. So if you have extra codeine, Oxycontin, valium or other controlled substances lying around, the DEA will dispose of them safely for you — and even do it greenly. (No illegal drugs though — or injectables).
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But will this straightforward strategy really address the rise in addictions and death? The data suggest that the issue is more complicated than you think.
The DEA’s take-back program addresses the reality that the vast majority of prescription drug misusers are not pain patients and that they tend to get their pills and patches from friends, dealers or by theft, rather than from doctors legitimately.
But the program overlooks another significant reality. As the New York Times puts it:
Skeptics, pointing to the dearth of evidence that gun buybacks have reduced the gun crime rate, question whether even a national take-back effort will have much impact. And they question whether most people will bother to participate when the take-back programs, unlike the gun programs, do not offer a reward for turning in pills.
There is also the reality that many people intentionally hang on to pain or anxiety medicine for future use.
Why do people hoard pain and anxiety pills? Obviously, most people feel more secure if they have the drugs around in case of an emergency. But the motivation runs much deeper than that: people fear that because of heightened attention to prescription drug misuse, their doctor may not prescribe what they need the next time they are suffering. And so they zealously keep whatever they can get.
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By fostering a panic around prescriptions, law enforcement actually perpetuates this problem. Legitimate patients fear being cut off, so they hoard drugs. This hoarding provides an opportunity for thieves and curious teens.
Misconceptions about who becomes addicted fuel the problem further. Research shows that the overwhelming majority of prescription drug misusers do not become addicted during pain treatment. For example, a 2007 study of nearly 28,000 addicts admitted to treatment between 2001 and 2004 found that 78% of those who used Oxycontin had never been prescribed it by a doctor for pain.
A new report on patients treated for prescription drug misuse released Friday found that they made up 5.6% of admissions to rehab — and 58% of this group had previously been treated for addiction.
Basically, people who become addicted to prescription opioids are similar to those who get addicted to illegal drugs: like heroin addicts, they tend to have been serious drug users involved in marijuana, cocaine or psychedelics before they got hooked on opioids.
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While many of these addicts later claim to have been coaxed into addiction under a doctor’s care, if you take a full history of their drug use, the vast majority of even those who start in legitimate pain treatment and become addicted have had previous histories of problems with drugs like cocaine.
The age at which users are admitted to treatment speaks to this: 86% of admissions involve people under 44, the majority being 25 to 34. Meanwhile, pain patients tend to be middle-aged or older — yet only 14% of those in treatment for addiction are 45 or older.
So, putting pressure on doctors to prescribe less for fear that they will cause addiction in patients misses the fact that most people who become addicted aren’t patients. That pressure isn’t going to deter most prescription drug addicts, who don’t get their drugs directly from doctors, but either share them with or steal them from friends or family. Instead, the pressure to crack down on prescriptions may lead to fear among patients that they won’t be able to get necessary medications, which leads to hoarding — which increases the supply available to addicts.
A better solution for prescription-drug misuse may be counterintuitive: less hype and less pressure on doctors to police patients in pain. That could make patients feel that painkillers and anxiety medications are more likely to be available when needed. A sense of more access would lead to less hoarding, which really would shrink the stealable or sharable supply.
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And, of course, if we actually wanted to reduce opioid-related deaths, we might want to make the antidote to opioid poisoning — which has been linked with large reductions in drug deaths when given to addicts — available.