10 Controversial Medical Questions Answered by Dr. Dalrymple
Where do you stand on these challenging ethical and scientific debates?
March 15, 2014 - 8:00 am
From September 2013:
8. Is drug addiction really just like any other illness?
Who can imagine an organization called Arthritics Anonymous whose members stand up and say “My name is Bill, and I’m an arthritic”?
Sometimes a single phrase is enough to expose a tissue of lies, and such a phrase was used in a recent editorial in The Lancet titled “The lethal burden of drug overdose.” It praised the Obama administration’s drug policy for recognizing “the futility of a punitive approach, addressing drug addiction, instead, as any other chronic illness.” The canary in the coal mine here is “any other chronic illness.”
The punitive approach may or may not be futile. It certainly works in Singapore, if by working we mean a consequent low rate of drug use; but Singapore is a small city state with very few points of entry that can hardly be a model for larger polities. It also seems to work in Sweden, which had the most punitive approach in Europe and the lowest drug use; but the latter may also be for reasons other than the punishment of drug takers. In most countries (unlike Sweden) consumption is not illegal, only possession. That is why there were often a number of patients in my hospital who had swallowed large quantities of heroin or cocaine when arrest by the police seemed imminent or inevitable. Once the drug was safely in their bodies (that is to say, safely in the legal, not the medical, sense), they could not be accused of any drug offense. Therefore, the “punitive approach” has not been tried with determination or consistency in the vast majority of countries; like Christianity according to G. K. Chesterton, it has not been tried and found wanting, it has been found difficult and left untried.
But the tissue of lies is implicit in the phrase “as any other chronic illness.” Addiction is not a chronic illness in the sense that, say, rheumatoid arthritis is a chronic illness. If it were, Mao Tse-Tung’s policy of threatening to shoot addicts who did not give up drugs would not have worked; but it did. Nor would thousands of American servicemen returning from Vietnam where they had addicted themselves to heroin simply have stopped when they returned home; but they did. Nor can one easily imagine an organization called Arthritics Anonymous whose members attend weekly meetings and stand up and say, “My name is Bill, and I’m an arthritic.”
Some people (but not presumably The Lancet) might say that it hardly matters what you call addiction. But calling it an illness means that it either is or should be susceptible of medical treatment. And one of the most commonly used medical “treatments” of heroin addiction is a substitute drug called methadone. According to The Lancet, though, 414 people died of methadone overdose in Great Britain in 2012, while 579 died of heroin and morphine overdose. Since fewer than 40 percent of heroin and morphine addicts are ‘”treated” with methadone, treatment probably results in more death than it prevents, at least from overdose. Moreover, some of the people it kills are the children of addicts.
The United States, with five times the population of Great Britain, has nearly fifteen times the number of drug-related deaths (38,329 in 2010). This, however, is not because illicit drug use is much greater than in Britain. It is because doctors in America are prescribing dangerous opioid drugs in huge quantities to large numbers of patients who mostly do not benefit from them. More people now die in the United States of overdoses of opioid drugs obtained legally than are murdered. It is not true, then, that all the harm of opioid misuse arises from its illegality.
Recently I asked a group of otherwise well-informed Americans whether they had heard of the opioid scandal. They had not.