Reviving The Failed “Just Say No” Drug Campaign

Trump’s Just Say No Campaign

Patients often try to discuss politics with me and I always avoid it the best I can.

I don’t care what folks believe, for here in the U-S-of-A I will not stop believing that every one of us has the right to choose.  I try to tell them I am about as apolitical a human as they are going to find.

Should they want to push me into a corner and find out if I am “left” or “right,” I try to convince them that I grew up in Boston and so am “fairly liberal,” or remind them I am a veteran of the United States Army Medical Corps, which is usually enough to make me pass for “conservative.”

Neither is true, of course.  American political thought is fairly frightening to me because it is a simple “duality.”  All people really want to know is a “yes or no” answer.  Nothing I ever believed about anything was a simple “yes-or-no” type answer.

The question “Is there really a God?” took years of multilingual research before mulch research has landed me generally in the Theist camp, but no slave to the traditions of my own faith that my parents used to “bring me up right.”

So it should come as no surprise to anyone who either has read me or has actually met me that I had a lot of trouble with the work that has so far come out of the emergency effort to combat the opioid epidemic. The complete text of the November 1st draft of the President’s Commission is here.

The above preamble is meant to let you understand that I did not go through this document (I actually read it all) trying to criticize it.  I went through it finding myself trying to find something that might actually work.

It is a piece of government bureaucracy that sounds like any other form of government bureaucracy.  The commission has no “teeth” — its function has nothing to do with actually coming up with the money to fund the 56 recommendations.  They may be sincere but they are idealistic and will be fairly difficult to implement at best, according to my knowledge of the system from within.

They, there is the question of if they would actually be effective if they were implemented.

I am not going to cite statistics. They are overwhelming and to most folks, unfathomable.  Just know that addicts are NOT street people without any visible opportunities for upward mobility.  They are your family, friends, and neighbors.  During my tenure at a clinic associated with a national chain of addiction centers, I even had some mega business moguls.

I remember being stared at by the saddest face in memory who told me:
“I made more money than you would believe if I told you, and then I put it all into my own arm.”

I will cite the recommendation for a major media blitz.  Does anyone but me remember the “Just Say ‘NO'” campaign from the 80’s??  I cannot find any evidence that it ever worked.  Nor do I see anything to suggest that the initiative described here will be any different or more effective.

It’s not just me. Those lovable Brits set up the first “Cochrane” reviews to review research evidence for various topics (other countries are now doing this) and they reviewed 24 papers out of 18,343 abstracts and papers that met their criteria for review, covering 184,811 folks and they came back with a more blanket condemnation of this kind of intervention than any results I have ever seen in Cochrane reports — which I have been referring to for many years as the gold standard of “evidence-based medicine.”

The great majority of the recommendations have to do with data-sharing among government agencies or enforcing existing guidelines.

As for the money, the good news is that we do have a Public Health Emergency Fund.  The bad news is that it only has about $57,000 dollars in it.

There are LOTS of folks on the net who have pointed out that the list of recommendations for combatting the opioid epidemic is going to cost billions and nobody seems to have any idea where the funds will come from.

Luckily, someone who seems to be a more experienced political-watcher than me has also, it would seem, read the whole thing.

Addicted offenders going to federal drug courts instead of prison? Are they going to be sentenced to forced detoxification and treatment?  Where?  Sounds to me like a bunch of new laws and a bunch of new institutions.

Better guidelines for opiate prescriptions by doctors?  I have lived through an era that mandated (in California) more aggressive use of medication to treat pain.  I tried not to pick a fight with the person running a live continuing medical education conference when I gently suggested everyone who claimed had pain ought to be assessed thoroughly before being given whatever they asked for.

“Unethical doctors?”  Everybody knows that there are some providers who are easier to get controlled substances from than others — especially the addicts.

There is a shortage of doctors.  They have been forced (by government agencies) to work more and to bring home less.  Even before I finished medical school, those who had graduated a bit before me (in France, but its really no different here) had a lot to say about how difficult it was to find and retain (i.e., “keep happy”) enough patients to make enough to support what was usually already a family with children.

At any rate, existing opioid guidelines are not doing the trick.  I have seen some “guidelines” about longer-term use but have never seen anything about acute use.  As a matter of fact, I remember not so long ago the profession actually seemed to believe there was not much if any danger of addiction from acute use.

Surprise, surprise.

The same folks got somebody to write about how to vanquish the epidemic.

Admit addiction is a disease.

Makes sense to me. This does not depend so much on being kind and offering help.

Addiction ought to be accepted as a disease financially and institutionally.  All insurances should be under legal obligation to cover addiction treatment.

More often than not, more of the time than anyone can imagine, there is underlying psychiatric illness or “dual diagnosis” — an artifact of our primitive diagnostic labelling systems.

Support Addiction treatment centers.

They are not all created equal, with many being mere insurance pumps — moneymaking enterprises, who rarely even measure their own rates of recidivism (retreatment) let alone make any effort to diminish them.

The following recommendations, to “educate” people and to “demand change” are difficult if not impossible to implement in a country where many people feel distant and alienated from public process. We have not even discussed the most trusted treatments for this disease — those “Anonymous” 12-step programs.

It is still, in addiction centers, fairly risky to speak out against Alcoholics Anonymous and Narcotics Anonymous, even though the standard of research I regard as reliable shows them to be 10 to 15% effective at best.  I see people every day who revolt against them as “religion” or have “failed” that system for one reason or another.  The paradigm has been applied to a lot of other “alleged” addictions, too.

Even with a division of the National Institutes of Health working on this problem, and with an increasing amount of knowledge about the chemical mechanisms involved, two people can take a drug simultaneously and one will end up an addict and another will not and nobody has explained this phenomenon to my satisfaction.

It is easy to say, “don’t start,” but who will listen?

If someone is looking for happiness or bliss, I am a (largely) happy and maybe even sometimes “blissful” woman.

Just seek your bliss elsewhere than from drugs.