OEDEL: Laws of addiction

February 23, 2014 

Georgia’s General Assembly is trying to find a responsible legal path through the confused, internally inconsistent thicket of federal marijuana law and enforcement. Meanwhile, other federally legal drugs are already wreaking havoc when abused.

The Centers for Disease Control and Prevention describe prescription drug abuse as an epidemic. Having tripled since 1990, drug overdoses now kill about as many Americans annually as car crashes. Because we’re not effectively registering deaths associated with drugged driving, our prescription drug problem is likely even deadlier than advertised.

In Georgia, not counting seven Atlanta-area counties, the GBI reports that 686 died from overdoses in 2012. Seventy-six percent of them died from prescription drugs alone. Ten percent more died from a mix of prescription and illicit drugs. Only 14 percent died solely from illicit drugs like cocaine and methamphetamine. Ninety percent of overdoses were accidental.

Who’s dying from these overdoses? If you think young people, disproportionately black, think again. The biggest age group is 45 to 54. Ninety-one percent are white, 54 percent male. Philip Seymour Hoffman, the 46-year-old white actor who’d been using prescription drugs before overdosing, fits that profile.

Hoffman’s final fix, though, was of an illicit Class I street drug presently unusual in Georgia: heroin. The four biggest killer drugs in Georgia, at least outside Atlanta are, in order, alprazolam (Xanax), oxycodone (OxyContin), methadone and hydrocodone (Lortab). Even if we combined the deaths associated with cocaine and methamphetamine, they’d still barely make third place.

But we don’t see billboards showing the deadly effects of Xanax and OxyContin. The public mistakenly imagines “street” drugs are the biggest killers, when prescription drugs kill far more.

Most states have responded by trying to circumvent the doctor-shopping tactics of addicts by legally mandating the use of comprehensive prescription databases. Georgia implemented its program only last May. It has real promise. A national database could further help circumvent addicts from exploiting state differences.

Another 2013 change in Georgia law required clinics providing pain management to be owned by licensed physicians, not non-doctor entrepreneurs. About 124 such clinics are now licensed in Georgia.

In downtown Macon recently, I noticed a Macon-Bibb DUI Task Force vehicle in a pain clinic’s parking lot. I asked the officer why he was guarding it. Nodding at some of the people hanging around in the parking lot waiting for their prescriptions, he said, “It’s a cash business.”

Cash may be risky, but drugs are, too, sometimes leaving their marks etched on people’s faces, frames and lives. Those marks seemed present in that lot. I wondered, but didn’t ask, if the officer found it ironic that he and his DUI vehicle were guarding that business when some of its customers might soon be driving under the influence after hitting the pharmacies.

What can be done to reduce overdose deaths? For one thing, Medicaid could quit dispensing painkillers at twice the normal population’s rate. We can also try to break addictions. Dr. Ralph Griffin, Coliseum Medical Centers’ emergency department director, told me that the hospital regularly refers overdosing or addicted patients to detox and treatment programs that can work.

Another approach could be to tighten doctors’ presumptive standards for prescribing drugs like Xanax, OxyContin, etc. Before hanging up on me and then having his lawyer give me a friendly call, Dr. Thomas Sachy, operator of a pain and behavioral medicine clinic in Gray, explained his philosophy that doctors should “give the benefit of the doubt” to patients complaining about pain and wanting meds. Sachy argued that pain’s nature is subjective.

Sachy’s philosophy makes patients happy. But do funerals follow? After overdose deaths, we should require checking to see where the drugs were obtained.

Ironically, the tighter medical practice and laws get with respect to regulating, prescribing and policing dangerous drugs, the more incentive there’ll be for addicts like Hoffman to jump to street substitutes. The natural laws of addiction aren’t wholly escapable.

But laws and medical rules, if carefully crafted, can still minimize the chance that susceptible people will become addicts and later die from overdosing. We can do better with more thoughtful laws and medical practice.

David Oedel teaches at Mercer University law school.

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