All drugs carry costs, risks, and harms as well as benefits. Illegal ones too. Americans can’t escape the toll of harm as they use and abuse recreational and illicit substances, recent news reports show.
With the long Labor Day weekend upcoming — the traditional summer’s end, with gatherings of friends and families for outdoor barbecues, relaxing, fun, and potentially drinking and use of marijuana or more — it may be worth taking note of some indicators of the serious problems associated with substance abuse:
- The nonprofit, independent RAND Corp. reported that its studies suggest that American drug users spent an estimated $150 billion on cocaine, heroin, marijuana, and methamphetamine in 2016 alone. The marijuana market is now roughly the size of the cocaine and methamphetamine markets combined, and the size of the retail heroin market is now closer to the size of the marijuana market than it is to the other drugs. Further, after plunging from 2006 to 2010, cocaine consumption’s decline slowed by 2015. Results suggest there were 2.4 million individuals who used cocaine on four or more days in the past month in 2015 and 2016. Results also suggest that consumption grew in 2016 among a stable number of users as price per pure gram declined. And heroin consumption increased 10% per year between 2010 and 2016. The introduction of fentanyl into heroin markets has increased the risk of using heroin. From 2010 to 2016, the number of individuals who used marijuana in the past month increased nearly 30%, from 25 million to 32 million. RAND experts estimate a 24% increase in marijuana spending over the same period, from $42 billion to $52 billion.
- The trendy use of e-cigarettes to vape has led to a confirmed death in Illinois and hundreds of cases of hospitalizations of young users in almost two dozen states. As the Washington Post reported: “The affected individuals have had symptoms including cough, shortness of breath and fatigue … Some also experienced vomiting and diarrhea. Symptoms worsened over a period of days or weeks before they were hospitalized.” Authorities are still investigating causes of this outbreak of lung illnesses connected to vaping. It may be tied to users’ intake of addictive nicotine or tetrahydrocannabinol, also known as THC. It is the chemical that produces marijuana’s high. With the drug’s increasing legalization in various forms in the preponderance of states and the District of Columbia, marijuana growers have cultivated and refined an increasingly potent product — which becomes even more so when processed into extracts for vaping. As for nicotine, the market dominating Juul device may trace some of its wide popularity to its capacity to provide users with a wallop of the chemical, even more so than smoking a pack of burning tobacco cigarettes. The most seriously ill patients, the New York Times reported, have “had extensive lung damage that required treatment with oxygen and days on a ventilator. Some are expected to have permanent lung damage.”
- Fentanyl’s insidious rise as a leading killer of Americans can be traced to laxity by the U.S. Postal Service, inattention by the Obama Administration, and underfunded and unfocused Trump Administration officials, the Washington Post reported in an unfolding, multipart series. This is the latest in what has become a powerful mountain of journalism from the newspaper about the opioid and overdose crisis in this country. It has morphed into its latest and lethal wave with fentanyl, a lab-created, exceedingly powerful painkiller that now is commonly made overseas (China, mostly) and then shipped too often by the U.S. Postal Service across this country. As the newspaper reported: “Fentanyl — 50 times more potent than heroin — has fueled the deadliest drug epidemic in American history. From 2013 through 2017, more than 67,000 people died of synthetic-opioid-related overdoses, the majority of them from fentanyl. In 2018, another 31,473 Americans died, according to the latest available figures from the Centers for Disease Control and Prevention. While prescription opioid overdoses fell last year, deaths from fentanyl rose, according to provisional data in a CDC report released in July. Fentanyl is the third wave of the opioid epidemic, which began with prescription pills, migrated to heroin and then morphed into the current crisis.”
Curiously, even as the news articles pour forth, especially from the Washington Post itself, the author of the newspaper’s daily health affairs newsletter presented a largely upbeat description of data, indicating a positive, “double digit decline” in opioids abuse. That view stemmed from information produced by the 2018 National Survey on Drug Use and Health, aka the annual report by the Substance Abuse and Mental Health Services Administration (SAMSHA).
Washington Post readers might not have been cautioned by other drug experts to look carefully at the SAMSHA information. It is a key source for researchers, and it can be useful in pointing to certain drug use and abuse trends. The SAMSHA work has notable limits, notably that it relies on a self-reporting national survey. Experts caution that as drugs become more potent and surrounded by illicit or criminal behaviors, user supplied data can be less reliable. Even with confidentiality assurances, how likely are survey respondents to fess up to criminal drug abuse in a government questionnaire? Federal officials, meantime, eliminated another means of collecting drug use data — a research project that involved questioning inmates in jails and prisons and the homeless. Experts say such individuals are most likely to be involved in illicit drug use and abuse and to give a more accurate picture of its severity and injury.
In my practice, I see not only the harms that patients suffer while seeking medical services, I see the havoc that can be wreaked on them and their families by dangerous drugs, notably Big Pharma’s prescription products and especially opioids. It took awhile for us to sink into this nightmare, and there is plenty of blame for it to go around — including for Big Pharma, doctors, nurses, hospitals, insurers, policy makers, regulators, and politicians.
The journalists, researchers, and Samaritans who keep poking at drug abuse and overdoses and their causes deserve credit and thanks for not only showing us how so much went wrong but also what we must do to make things right.
This clearly includes providing drug addiction treatment, especially through medication-based treatment using the overdose antidote and anti-craving drug buprenorphine. Such care is covered and most accessible under the Medicaid program that provides health coverage for the poor and working poor. It was expanded under the Affordable Care Act aka Obamacare — and this has proved vital to combating the opioid crisis in states hardest hit. But Republicans in the White House and Congress want to slash Medicaid.
Is this what voters want? They will get their say in 2020, and the presidential and congressional campaigns for that election will step up even more as the nation heads into the fall. Enjoy the restful, fun, and safe holiday weekend that marks the summer’s end. If you’re drinking or smoking or vaping or using recreational drugs, please think hard about those substances’ health harms — and be moderate and safe in your conduct. We all have lots to do in the days ahead to be healthier and happier.