Recovery Michigan

Thanks to advances in neurobiology over the past several decades, opioid addiction is now understood to be a brain disease that arises from chronic exposure to opioids. Repeated exposure in persons who are vulnerable (due to genetic, environmental, or developmental factors) causes the brain to adapt in ways that can induce compulsive drug use and loss of control over drug-related behaviors. Opioid addiction can occur both in individuals who use opioids medically and in those who engage in prescription opioid abuse, defined as the use of an opioid medication without a prescription, in a way other than as prescribed, or for the experience or feelings elicited. In short, addiction that once would have been considered “moral weakness” is now understood to have a biological basis.

We also know that over-prescribing (particularly for chronic pain) is a major driver fueling prescription opioid addiction. The overall sale of opioid analgesic painkillers, which increased nearly four-foldbetween 1999 through 2010, parallels observed increases in opioid-related overdose deaths, emergency department visits, and treatment admissions.

In 2012 alone, providers issued 259 million opioid prescriptions — enough for every adult to have their own bottle of pills. A heightened focus on pain management beginning in the 1990s liberalized opioid prescribing, but this shift spurred tremendous growth in prescription drug abuse and addiction. Today,over 85 percent of abused prescription drugs, including opioids, are sourced directly or indirectly from prescribers.

We are less clear about the relationship between prescription opioid and heroin abuse. There is some evidence that prescription opioid addicts may have switched to cheaper, deadlier heroin when they couldno longer easily tamper with Oxycontin after its reformulation. However, a more recent review suggests that the escalation of heroin-related overdose deaths predated policy efforts to curb prescription opioid abuse — albeit a subset of prescription opioid abusers may transition to heroin use.

Although the effectiveness of most of the above-mentioned “wise” policies has yet to be proven, they at least recognize the prescription opioid epidemic as a public health priority rather than a criminal justice matter. Still, there are some opioid addiction policy responses that are ill-conceived in that they focus on criminalizing or punishing the behavior of opioid addicts, rather than preventing or treating it.

For instance, a majority of states allow law enforcement officials to access information in their state’s prescription drug monitoring program to identify and prosecute potential drug abusers. Doctor shopping laws (that typically echo federal drug control laws) make it a crime to intentionally obtain drugs by fraud or deceit. Tennessee, among other states, has criminalized the use of drugs by pregnant women. Moreover, there is inadequate treatment provided both within prisons and upon release of prisoners with opioid or other addiction disorders.